TY - JOUR
T1 - Routine transthoracic echocardiography in ischaemic stroke or transient ischaemic attack of undetermined cause
T2 - a prospective multicentre study
AU - van der Maten, Gerlinde
AU - Meijs, Matthijs F.L.
AU - Timmer, Jorik R.
AU - Brouwers, Paul J.A.M.
AU - von Birgelen, Clemens
AU - Coutinho, Jonathan M.
AU - Bouma, Berto J.
AU - Kerkhoff, Henk
AU - Helming, Anne Mijn
AU - van Tuijl, Julia H.
AU - van der Meer, Nicolet A.
AU - Saxena, Ritu
AU - Ebink, Corné
AU - van der Palen, Job
AU - den Hertog, Heleen M.
N1 - Funding Information:
This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw): project number 843004113. The funder of the study had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2023, The Author(s).
PY - 2024/2
Y1 - 2024/2
N2 - Background : Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes. Methods : Six Dutch hospitals conducted a prospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE. Results : From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11 (1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. A single patient (0.1%) showed a major CSE despite having no ECG abnormality. Conclusions : This multicentre cross-sectional study in patients who—after workup on contemporary stroke units—were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.
AB - Background : Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes. Methods : Six Dutch hospitals conducted a prospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE. Results : From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11 (1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. A single patient (0.1%) showed a major CSE despite having no ECG abnormality. Conclusions : This multicentre cross-sectional study in patients who—after workup on contemporary stroke units—were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.
KW - Brain ischaemia
KW - Echocardiography
KW - Embolism
KW - Transient ischaemic attack
UR - http://www.scopus.com/inward/record.url?scp=85174589526&partnerID=8YFLogxK
U2 - 10.1007/s12471-023-01819-7
DO - 10.1007/s12471-023-01819-7
M3 - Article
AN - SCOPUS:85174589526
SN - 1568-5888
VL - 32
SP - 91
EP - 98
JO - Netherlands heart journal
JF - Netherlands heart journal
IS - 2
ER -
