Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke
Objective: Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS worku...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2020.00103/full |
| _version_ | 1818885279475302400 |
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| author | Jennifer Harris Jason Yoon Mohamed Salem Mohamed Salem Magdy Selim Sandeep Kumar Vasileios Arsenios Lioutas |
| author_facet | Jennifer Harris Jason Yoon Mohamed Salem Mohamed Salem Magdy Selim Sandeep Kumar Vasileios Arsenios Lioutas |
| author_sort | Jennifer Harris |
| collection | DOAJ |
| description | Objective: Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age >18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of <35%. Secondary endpoint was the proportion of patients who had a TTE-drive change in management.Results: Among 548 AIS patients (median age 71 [59–81] years, 50% female), 482 (87%) underwent TTE. Clinically relevant findings were observed in 183 (38%) patients, leading to additional workup in 41 (8.5%). Further workup was associated with younger median age (58 [50–65] vs. 72 [62–81], p < 0.0001, and was less likely in suspected large vessel etiology (p = 0.02). Abnormal TTE lead to treatment change in 24 (5%) patients; 22/24 were started on anticoagulation. TTE results were less likely to influence treatment changes in older patients (71 [60–80] vs. 58 [49–69] years, p = 0.02) with known atrial fibrillation (p = 0.01).Conclusion: Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization. |
| first_indexed | 2024-12-19T16:02:55Z |
| format | Article |
| id | doaj.art-136575c41bba4001a69491e52f9f9e7b |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-19T16:02:55Z |
| publishDate | 2020-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-136575c41bba4001a69491e52f9f9e7b2022-12-21T20:14:54ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-02-011110.3389/fneur.2020.00103508655Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic StrokeJennifer Harris0Jason Yoon1Mohamed Salem2Mohamed Salem3Magdy Selim4Sandeep Kumar5Vasileios Arsenios Lioutas6Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesDepartment of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United StatesObjective: Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age >18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of <35%. Secondary endpoint was the proportion of patients who had a TTE-drive change in management.Results: Among 548 AIS patients (median age 71 [59–81] years, 50% female), 482 (87%) underwent TTE. Clinically relevant findings were observed in 183 (38%) patients, leading to additional workup in 41 (8.5%). Further workup was associated with younger median age (58 [50–65] vs. 72 [62–81], p < 0.0001, and was less likely in suspected large vessel etiology (p = 0.02). Abnormal TTE lead to treatment change in 24 (5%) patients; 22/24 were started on anticoagulation. TTE results were less likely to influence treatment changes in older patients (71 [60–80] vs. 58 [49–69] years, p = 0.02) with known atrial fibrillation (p = 0.01).Conclusion: Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization.https://www.frontiersin.org/article/10.3389/fneur.2020.00103/fulltransthoracic echocardiographyischemic strokediagnosticsstroke diagnosisstroke etiologyresource utilization |
| spellingShingle | Jennifer Harris Jason Yoon Mohamed Salem Mohamed Salem Magdy Selim Sandeep Kumar Vasileios Arsenios Lioutas Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke Frontiers in Neurology transthoracic echocardiography ischemic stroke diagnostics stroke diagnosis stroke etiology resource utilization |
| title | Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke |
| title_full | Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke |
| title_fullStr | Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke |
| title_full_unstemmed | Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke |
| title_short | Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke |
| title_sort | utility of transthoracic echocardiography in diagnostic evaluation of ischemic stroke |
| topic | transthoracic echocardiography ischemic stroke diagnostics stroke diagnosis stroke etiology resource utilization |
| url | https://www.frontiersin.org/article/10.3389/fneur.2020.00103/full |
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