Mike Fralick1, Nicola Goldberg2, Sagar Rohailla2, Yishan Guo2, Matthew J Burke2, Lauren Lapointe-Shaw2, Janice L Kwan2, Adina S Weinerman2, Shail Rawal2, Terence Tang2, Fahad Razak2, Amol A Verma2. 1. Division of General Internal Medicine (Fralick, Goldberg, Rohailla, Razak, Verma) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Guo), St. Michael's Hospital, Toronto, Ont.; Department of Neurology (Burke), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Department of Medicine (Lapointe-Shaw, Rawal), University of Toronto; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont.; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners, Mississauga, Ont. mike.fralick@mail.utoronto.ca. 2. Division of General Internal Medicine (Fralick, Goldberg, Rohailla, Razak, Verma) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Guo), St. Michael's Hospital, Toronto, Ont.; Department of Neurology (Burke), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of General Internal Medicine (Lapointe-Shaw, Rawal), University Health Network; Department of Medicine (Lapointe-Shaw, Rawal), University of Toronto; Division of General Internal Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont.; Program of Medicine and Institute for Better Health (Tang), Trillium Health Partners, Mississauga, Ont.
Abstract
BACKGROUND: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. METHODS: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression. RESULTS: Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram (n = 110), a PFO was detected in 19 (17%) on transthoracic echocardiogram. INTERPRETATION: Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.
BACKGROUND: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. METHODS: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression. RESULTS: Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram (n = 110), a PFO was detected in 19 (17%) on transthoracic echocardiogram. INTERPRETATION: Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.
Authors: A J Grau; C Weimar; F Buggle; A Heinrich; M Goertler; S Neumaier; J Glahn; T Brandt; W Hacke; H C Diener Journal: Stroke Date: 2001-11 Impact factor: 7.914
Authors: Edward Haosheng Yu; Codrin Lungu; Ronald M Kanner; Richard Benjamin Libman Journal: J Stroke Cerebrovasc Dis Date: 2009 May-Jun Impact factor: 2.136