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Cardiac abnormalities in stroke patients with negative arteriograms
Insights
Electrocardiograms (ECG) and two-dimensional echocardiograms (2DE) detect cardiac abnormalities in TIA and stroke patients. However, definite embolic abnormalities are rare, with ECG and patient history identifying most cases.
Area of Science:
- Cardiology
- Neurology
- Diagnostic Imaging
Background:
- Transient ischemic attack (TIA) and stroke patients with nondiagnostic arteriograms require investigation for embolic sources.
- Cardiac abnormalities are a potential cause of embolic stroke.
Purpose of the Study:
- To determine the incidence of cardiac abnormalities that could cause embolic stroke in patients with recent TIA or stroke.
- To compare the diagnostic yield of electrocardiograms (ECG) and two-dimensional echocardiograms (2DE) in identifying emboligenic cardiac sources.
Main Methods:
- Sixty-five consecutive patients with recent TIA or stroke and nondiagnostic arteriograms underwent ECG and 2DE.
- Cardiac abnormalities were classified by their probability of causing embolic events: non-specific, possible emboligenic abnormality (PEA), or definite emboligenic abnormality (EA).
Main Results:
- While 51% of patients had abnormal 2DE and 59% had abnormal ECG, many findings were nonspecific.
- Definite emboligenic abnormalities (EA) were found in only 6% on ECG and 3% on 2DE.
- Two-dimensional echocardiography (2DE) provided minimal additional information beyond ECG and patient cardiac history.
Conclusions:
- In TIA and stroke patients with negative arteriograms, ECG and prior cardiac history are effective in identifying most patients with definite emboligenic abnormalities.
- The incidence of definite emboligenic cardiac abnormalities is low in this patient population.
- 2DE offers limited added value over ECG and clinical assessment for detecting embolic sources in these patients.
Abstract:
Sixty-five consecutive patients with recent unequivocal TIA (33) or stroke (32), but nondiagnostic arteriograms, had two-dimensional echocardiograms (2DE) and electrocardiograms (ECG) to determine the incidence of cardiac abnormalities which could cause embolic stroke. Abnormalities were classified according to increasing probability of causing an embolic event: non-specific, possible emboligenic abnormality (PEA) or definite emboligenic abnormality (EA). Although 2DE was abnormal in 33 patients (51%), and ECG in 38 (59%), many abnormalities were nonspecific. Only four patients (6%) had EA on ECG and two (3%) on 2DE. Since one patient had EA on both tests, 2DE identified only one patient (mitral valve prolapse) not already identified by ECG. All patients with EA had a prior history of cardiac disease. PEA was present on ECG in 11 patients (17%), and on 2DE in 25 (38%). There was no correlation between age, CT results, or neurologic symptoms commonly associated with embolic stroke and the presence of EA or PEA on ECG or 2DE. Although TIA and stroke patients with negative arteriograms have a high incidence of abnormalities on ECG and 2DE, the percentage of patients with EA is low, and cardiac history and ECG identify most patients. 2DE provides little additional information.