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Cardioembolic stroke: results from three current stroke data banks
C R Hornig1, M Brainin, H Mast
1Department of Neurology, University Hospital Giessen, Germany.
Insights
Cardiogenic embolism causes 17% of strokes and transient ischemic attacks (TIA). While standard tests often identify the source, widespread transesophageal echocardiography screening did not significantly increase diagnoses but did find minor risks.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Cardiogenic embolism is a significant cause of ischemic stroke and TIA.
- Identifying embolic sources is crucial for patient management and secondary prevention.
Purpose of the Study:
- To determine the proportion of strokes and TIAs caused by cardiogenic embolism.
- To evaluate the diagnostic yield of transesophageal echocardiography in stroke patients.
Main Methods:
- Analysis of data from three prospective stroke registries (Berlin, Giessen, Klosterneuburg).
- Assessment of diagnostic methods including history, clinical examination, ECG, echocardiography, and transesophageal echocardiography.
Main Results:
- Approximately 17% of ischemic strokes and TIAs were attributed to cardiogenic embolism.
- Standard diagnostic methods were effective in identifying most cardiogenic embolic sources.
- Transesophageal echocardiography screening did not substantially increase the diagnosis rate of cardiogenic embolism but identified minor-risk sources.
Conclusions:
- Cardiogenic embolism is a common cause of stroke and TIA.
- Conventional diagnostic approaches are largely sufficient for identifying embolic sources.
- Prognosis after cardiogenic brain embolism is not worse than previously assumed.
Abstract:
About 17% of all transient ischemic attacks (TIA) and ischemic strokes were due to cardiogenic embolism in three prospective stroke registries (Berlin, Giessen, Klosterneuburg). Most of these patients can be identified by history, clinical examination, conventional ECG, and appropriate use of echocardiography. Widespread screening of stroke patients with transesophageal echocardiography, as intented in the protocol of two registries, did not appreciably increase the portion of patients with the final diagnosis of cardiogenic embolism, although, in many cases, minor-risk embolic sources can be identified. Prognosis for death or early recurrence after cardiogenic brain embolism was not worse than assumed previously.