Stratifying the Utility of Transthoracic Echocardiography for Ischemic Stroke Using a Risk Score.

Area of Science:

• Neurology
• Cardiology
• Medical Informatics

Background:

• Inpatient transthoracic echocardiography (TTE) is crucial for secondary prevention in acute ischemic stroke but can delay patient discharge.
• A need exists for a tool to identify patients most likely to benefit from TTE during hospitalization.

Purpose of the Study:

• To develop and validate a risk score to predict the likelihood of positive findings on inpatient transthoracic echocardiography (TTE) for patients with acute ischemic stroke or transient ischemic attack (TIA).

Main Methods:

• A logistic regression model was developed using a training dataset of 874 patients with acute ischemic stroke/TIA who underwent TTE.
• The model, AL2OHA, was simplified with limited variables and coefficients.
• External validation was performed using a separate dataset of 200 stroke patients.

Main Results:

• The AL2OHA model, comprising six variables (atrial fibrillation, large artery atherosclerosis, large vessel occlusion, obesity, prior antihypertensive medication, and age group), demonstrated good predictive performance.
• The area under the receiver operator characteristic curve (AUC) was 0.78 on the training data and 0.73 on the validation data.
• The model effectively stratified patients based on their risk of positive TTE findings, with higher scores correlating to increased likelihood.

Conclusions:

• The AL2OHA risk score is a valuable clinical tool for stratifying patients admitted for acute ischemic stroke/TIA.
• It helps determine which patients are most likely to benefit from an inpatient TTE, potentially optimizing resource utilization and patient care.