Diagnostic yield and therapeutic impact of transthoracic echocardiography in patients with potential cardiac sources of cerebral embolism

ABSTRACT

To explore the diagnostic yield of transthoracic echocardiography [TTE], and assess the effect of echocardiographic findings on subsequent therapy. In this retrospective study, we reviewed TTE reports and hospital records of patients diagnosed with a stroke or transient ischemic attack [TIA], screening for potential cardiac sources of embolism [CSE] from January 2006 to December 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia by considering at least 15 predefined TTE criteria. The therapeutic interventions employed as a consequence of the TTE findings were sought. We analyzed 240 patients [mean patient age 58.5 +/- 14] out of 10563 TTEs. While only one patient exhibited a definite CSE on TTE, potential CSEs were found in 35 patients [14.6%], most commonly caused by left ventricular [LV] systolic dysfunction [31.4%], followed by LV regional wall motion abnormalities [25.7%]. Multivariate analysis revealed 2 independent predictors for identifying a CSE on TTE history of coronary artery disease [odds ratio [OR] 6.2, 95% confidence interval [CI]2.6-14.8, p=0.0001], and nationality [OR 0.16, 95% CI 0.3-0.7, p=0.019]. The TTE findings affected therapy in only 3 patients [1.2%]. The TTE performed to exclude a CSE in patients with stroke or TIA resulted in low diagnostic yield, and had little impact on therapeutic decisions. Future refinement of clinical strategies to predict a CSE is needed to improve diagnosis, and possibly cost-effectiveness, of TTE