Henk Kerkhoff (Netherlands)
Albert Schweitzer Hospital NeurologyAuthor Of 1 Presentation
THE OPTIMAL APPROACH OF TRANSTHORACIC ECHOCARDIOGRAPHY IN ISCHEMIC STROKE OR TIA OF UNDETERMINED CAUSE: THE ATTEST STUDY
Abstract
Background and Aims
Although guidelines recommend routine transthoracic echocardiography (TTE) after ischemic stroke or TIA of undetermined cause, scientific evidence is limited. Hence, we aimed to determine the prevalence of echocardiographic abnormalities, detected with this routine use of TTE, which lead to therapeutic changes (i.e. major cardiac sources of embolism (CSE)).
Methods
We performed a prospective multicenter cross-sectional study that aimed to include all patients with ischemic stroke or TIA of undetermined cause in six hospitals in the Netherlands. After standard diagnostic evaluation including blood chemistry,12-lead ECG, continuous ECG-monitoring for at least 24 hours, brain imaging with CT or MRI, and imaging of the carotid arteries, these patients underwent TTE. The primary outcome measure was the prevalence of patients with major CSE on TTE, except for patent foramen ovale (PFO).
Results
From March 2018 to October 2020, 1085 patients were included. Mean age was 66.6±12.5 years, 629 (58.0%) patients were male, and 870 (80.2%) had ischemic stroke. In 12 patients (1.1%) a major CSE was detected. Major ECG abnormalities (i.e. signs of previous infarction or left bundle branch block) were seen in 10 of these 12 patients (with major CSE) and in 109 of 1058 patients without major CSE (83.3% vs. 10.3%, p<0.001).
Conclusions
In this large-scale prospective multicenter study, the prevalence of major CSE was low. Most patients with major CSE also had major ECG abnormalities. Our data suggest a more selective strategy in patients with ischemic stroke or TIA of undetermined cause, in which only patients with major ECG abnormalities are referred for TTE.