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Role of routine transthoracic echocardiography in evaluation and management of stroke
J R Beattie1, D J Cohen, W J Manning
1Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Insights
Routine transthoracic echocardiography (TTE) reveals age-dependent findings in patients with cerebral ischemia. While TTE is valuable for younger stroke patients, its utility is limited in those over 45.
Area of Science:
- Cardiology
- Neurology
- Diagnostic Imaging
Background:
- Cerebral ischemia, or stroke, can have cardiac origins.
- Transthoracic echocardiography (TTE) is a non-invasive imaging technique used to assess cardiac structure and function.
Purpose of the Study:
- To evaluate the diagnostic yield of routine TTE in patients experiencing cerebral ischemia without a prior cardiac diagnosis.
- To determine the clinical utility of TTE findings in relation to patient age.
Main Methods:
- A literature review was conducted, focusing on studies published between 1990 and 1995.
- Prevalence and stroke recurrence risk data for specific cardiac abnormalities (e.g., patent foramen ovale, atrial septal aneurysm, valvular stenosis, thrombi, cardiomyopathy) were analyzed.
- Data were stratified for adult patients younger and older than 45 years.
Main Results:
- TTE findings and stroke recurrence risk vary significantly with age.
- Patent foramen ovale is prevalent in nearly half of younger stroke patients, whereas TTE yields no significant findings in three-quarters of patients over 45.
- Warfarin therapy shows benefit for specific conditions like mitral stenosis and left atrial/ventricular thrombi, but its efficacy is unproven for patent foramen ovale or atrial septal aneurysm.
Conclusions:
- Optimal management strategies for most TTE findings in stroke patients remain undefined.
- Further research is necessary to establish appropriate therapeutic guidelines for TTE-identified cardiac abnormalities in the context of cerebral ischemia.
Objective:
To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease.
Design:
The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.
Results:
Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality.
Conclusion:
For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.