Abstract WP126: Utility of Transthoracic Echocardiography in Guiding Secondary Stroke Prevention
Background and Purpose Transthoracic Echocardiography (TTE) has long played a role in determining mechanism of, and ultimately secondary prevention for, acute ischemic stroke. We hypothesized that, based on recently published trials regarding secondary stroke prevention in the setting of patent foramen ovale (PFO) and reduced ejection fraction (EF), TTE results may not influence treatment decisions as greatly as they have previously.
Methods We retrospectively evaluated 583 consecutive TTEs performed at our stroke center from January 2009 through June 2012. Findings of interest that currently or previously would have affected management included chamber thrombus, mitral/aortic valvular disease (including endocarditis), reduced EF (<35%), PFO, intracardiac tumor, and atrial septal or left ventricular aneurysm. Based on the current evidence, only chamber thrombus, valvular disease, and intracardiac tumor were considered still to be management-changing.
Results A total of 51 cases (8.75%) yielded findings of interest. When excluding reduced EF and PFO in light of recent evidence, in only six cases (1.03%) were results considered to be management changing. The number needed to treat with TTE to diagnose one management-changing finding was 98. The cost of TTE at our center is approximately $500.
Conclusion TTE has long been part of the routine evaluation of acute ischemic stroke. In our series, the most common potential stroke risk factors identified on TTE were reduced EF and PFO. Currently available data suggest that these findings may no longer drive clinical practice. Cost effectiveness analysis is warranted to investigate the clinical utility of TTE in the evaluation of the acute stroke patient moving forward.
- © 2012 by American Heart Association, Inc.