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Cardiac abnormalities in stroke patients with negative arteriograms.

D C Good, S Frank, S Verhulst

    Stroke
    |January 1, 1986
    PubMed
    Summary

    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.

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    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).

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    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.