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(Stroke. 2006;37:11.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Therapeutic Implications for Routine Transthoracic Echocardiography in Acute Ischemic Stroke Patients

Department of Neurosciences, Monash Medical Centre, Australia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the article by de Abreu et al¹ on the topic of identifying the stroke mechanism in patients with sinus rhythm. These investigators raise 2 important issues: (1) the need to identify the mechanisms of stroke, and (2) therapy of patients with abnormal cardiac echo findings. The rationale for this study appears to be a lack of emphasis in the current guidelines that echocardiography is "an essential test."^2,3 They have identified a significant proportion of hospitalized stroke patients with some echocardiographic abnormalities. However, based only on a prevalence study of echocardiographic features, they draw rather strong conclusions regarding the need for routine echocardiography in acute ischemic stroke patients.

We agree that echocardiography can assist in clarifying the mechanism of ischemic stroke. However, we dispute the claim that echocardiography is an essential test in all ischemic stroke patients including those in sinus rhythm. The need for routine echocardiography ischemic stroke needs to be supported by strong evidence for a benefit from therapy, namely prophylactic anticoagulation. Of all the cardiac conditions listed in Table 2 of the article, only anterior wall dyskinesis or reduced ejection fraction from a recent anterior myocardial infarction can justify the use of warfarin, albeit for 3 months only.⁴ Although there is level I evidence that anticoagulation prevents stroke in patients with atrial fibrillation,⁵ there is no such support at present for routine anticoagulation for stroke prophylaxis in people with sinus rhythm even among high-risk patients with heart failure.⁶ This lack . . . [Full Text of this Article]

Tiago Tribolet de Abreu, MD; Sónia Mateus, BS José Correia, MD

Hospital do Espírito Santo-Évora, Largo Sr. da Pobreza, Évora, Portugal

Mark J. Alberts, MD

Department of Neurology, Northwestern University, Chicago, IL