Rendimiento diagnóstico del estudio ecocardiográfico en el accidente cerebrovascular: ¿debemos mejorar la selección de los pacientes? / Diagnostic yield of echocardiography in stroke: should we improve patient selection?

Introducción: El pasado año la Sociedad Europea de Ecocardiografía publicó las recomendaciones para el empleo del ecocardiograma en la identificación de las potenciales fuentes embolígenas como causa de accidente isquémico cerebral en ausencia de otra enfermedad cerebrovascular. Tanto el ecocardiograma transtorácico como el ecocardiograma transesofágico desempeñan un papel fundamental en la evaluación, el diagnóstico y el manejo de la fuente embolígena. Debido en parte a la mayor longevidad de la población y a la mejor supervivencia de los pacientes cardiológicos, asistimos, actualmente, a un incremento progresivo de la solicitud de estudios ecocardiográficos como prueba diagnóstica; esto nos ha llevado a analizar críticamente el rendimiento de los mismos. Objetivo: Analizar la rentabilidad diagnóstica del ecocardiograma transtorácico en pacientes con diagnóstico de ictus isquémico en un hospital de tercer nivel. Material y métodos: Hemos analizado retrospectivamente todos los estudios ecocardiográficos solicitados durante el año 2010 desde el servicio de neurología con diagnóstico de ictus isquémico. Se ha estudiado la eficacia diagnóstica de la prueba y su aportación al diagnóstico etiológico en función de los hallazgos ecocardiográficos mayores y menores, según las recomendaciones de la Sociedad Europea de Ecocardiografía. Resultados: Se encontraron criterios ecocardiográficos mayores en 6 pacientes (5%) de los catalogados como de perfil embólico y en 2 (0,7%) de los no embólicos, siendo la diferencia estadísticamente significativa, p=0,005. A la vista de nuestros resultados, la realización de ETT en pacientes con ictus no embólicos tiene un bajo rendimiento diagnóstico, lo que nos lleva a plantearnos la rentabilidad del uso sistemático de esta prueba(AU)

Introduction: Last year the European Society of Echocardiography published recommendations for the use of echocardiography in identifying potential sources of embolism as a cause of ischaemic stroke in the absence of other cerebrovascular disease. Both transthoracic echocardiography (TTE) and transoesophageal echocardiography play a fundamental role in the assessment, diagnosis and management of the embolic source. Due, in part, to the increased longevity of the population and improved survival of cardiac patients, we are now seeing a gradual increase in the application of echocardiographic studies as a diagnostic test. This has led us to critically analyse their performance in the various pathologies. Objective: Our aim was to analyse the diagnostic yield of TTE in patients with cerebrovascular accident in a tertiary hospital. Materials and methods: For this, we retrospectively analysed all echocardiographic studies during 2010 requested from the Neurology Department with a diagnosis of stroke. We have studied the diagnostic yield of the test and its contribution to the etiological diagnosis based on major and minor echocardiographic criteria as recommended by the European Society of Echocardiography. Results: We found major echocardiographic criteria in 6 patients (5%) with embolic stroke and in 2 (0.7%) non-embolic stroke, P=0.005. In view of our results, the performance of TTE in patients with embolic stroke has a low diagnostic yield, which leads us to consider the systematic use of this technique(AU)

Diagnostic yield of echocardiography in stroke: should we improve patient selection?

INTRODUCTION: Last year the European Society of Echocardiography published recommendations for the use of echocardiography in identifying potential sources of embolism as a cause of ischemic stroke in the absence of other cerebrovascular diseases. Both transthoracic echocardiography and transesophageal echocardiography play a fundamental role in the assessment, diagnosis and management of the embolic source. Due in part to the increased longevity of the population and improved survival of cardiac patients, we are now seeing a gradual increase in the application of echocardiographic studies as a diagnostic test. This has led us to critically analyse their performance in detecting various pathologies. OBJECTIVE: Our aim was to analyse the diagnostic yield of transthoracic echocardiography in patients with cerebrovascular accident in a tertiary hospital. MATERIAL AND METHODS: To this end, we retrospectively analysed all echocardiographic studies during 2010 requested from the Neurology Department with a diagnosis of stroke. We have studied the diagnostic yield of the test and its contribution to the etiological diagnosis based on major and minor echocardiographic criteria as recommended by the European Society of Echocardiography. RESULTS: We found major echocardiographic criteria in 6 patients (5%) with embolic stroke and in 2 (0.7%) non embolic, P=.005. In view of our results, the performance of transthoracic echocardiography in patients with embolic stroke has a low diagnostic yield, which leads us to question systematic use of this technique.