Abstract W P175: Diagnostic Yield of Echocardiography in Patients Presenting with Transient Ischemic Attack
Background: Transthoracic (TTE) or transesophageal (TEE) echocardiography is often performed to identify a cardioembolic (CE) source as part of the TIA evaluation. However, TTE/TEE can be difficult to obtain on an urgent basis, and the diagnostic yield in TIA remains undetermined.
Methods: Patients with presumed TIA (defined as acute onset of focal symptoms lasting <24 hours likely due to a vascular cause) within 48 hours after presentation were prospectively enrolled at 3 stroke centers. Data regarding clinical features, medical history, results of diagnostic testing including TTE/TEE, treatment at discharge, and 90-day outcome were recorded. TIA etiology was determined by the enrolling investigator from all available information. CE sources were defined using a modified version of the Causative Classification of Stroke system.
Results: A total of 633 TIA patients were included. Mean age was 66 ± 15 years, 52% were male, and the median ABCD2 score was 4 (IQR 3-5). The 90 day stroke rate was 2% (12/633). TIA mechanism was determined to be CE in 16% of subjects. Echocardiography was performed in 495 subjects (TTE alone in 444, TTE+TEE in 44, and TEE alone in 7). TTE revealed a CE source in 45/488 (9%) patients. TEE revealed a CE source in 17/51 (33%) patients, of whom 9 had either negative TTE or TTE was not performed. Therefore, the overall yield of TTE/TEE for a CE source was 54/495 (11%). The most common CE source detected on TTE/TEE was dilated cardiomyopathy; CE sources not detected on TTE/TEE consisted mostly of atrial fibrillation. Anticoagulation was initiated because of a CE source found on TTE/TEE in 19/495 (4%) patients. Of those who underwent an MRI, 169/495 (34%) were DWI+. Yield of both TTE and TEE tended to be higher in DWI+ compared to DWI- subjects (TTE: 17/146 [12%] vs 17/235 [7%], p=0.14; TEE: 12/27 [44%] vs. 1/15 [7%], p=0.01).
Conclusions: TTE and TEE identify a CE source and prompt a change in antithrombotic regimen with sufficient frequency to consider their inclusion in the diagnostic evaluation of patients with TIA. The yield of these tests, particularly TEE, is higher in patients with diffusion restriction on MRI.
Author Disclosures: C.A. Wilson: None. W. Tai: None. J.A. Desai: None. J. Olivot: None. S.B. Coutts: None. G.W. Albers: None. B.L. Cucchiara: None.
- © 2014 by American Heart Association, Inc.