Value of routine echocardiography in the management of stroke.
Journal
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805
Informations de publication
Date de publication:
06 08 2019
06 08 2019
Historique:
accepted:
14
06
2019
entrez:
8
8
2019
pubmed:
8
8
2019
medline:
24
4
2020
Statut:
ppublish
Résumé
Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression. Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram ( Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.
Sections du résumé
BACKGROUND
Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention.
METHODS
We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression.
RESULTS
Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram (
INTERPRETATION
Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.
Identifiants
pubmed: 31387955
pii: 191/31/E853
doi: 10.1503/cmaj.190111
pmc: PMC6682481
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E853-E859Informations de copyright
© 2019 Joule Inc. or its licensors.
Déclaration de conflit d'intérêts
Competing interests: Amol Verma and Fahad Razak report that they are part-time employee of Health Quality Ontario, as the Provincial Clinical Leads for Quality Improvement in General Internal Medicine. No other competing interests were declared.
Références
Cerebrovasc Dis. 2000;10 Suppl 3:12-21
pubmed: 10940666
Stroke. 2001 Nov;32(11):2559-66
pubmed: 11692017
Ann Intern Med. 1992 Sep 15;117(6):461-5
pubmed: 1503349
J Neurol Neurosurg Psychiatry. 2004 Oct;75(10):1421-5
pubmed: 15377689
Stroke. 2005 Jul;36(7):1565-6
pubmed: 15947277
Stroke. 2005 Aug;36(8):1776-81
pubmed: 16020772
J Stroke Cerebrovasc Dis. 2007 Jan-Feb;16(1):1-7
pubmed: 17689384
Cerebrovasc Dis. 2008;25(5):457-507
pubmed: 18477843
J Stroke Cerebrovasc Dis. 2009 May-Jun;18(3):178-84
pubmed: 19426886
Stroke. 2009 Aug;40(8):2893-8
pubmed: 19478214
Eur J Echocardiogr. 2010 Jul;11(6):461-76
pubmed: 20702884
J Stroke Cerebrovasc Dis. 2012 Oct;21(7):577-82
pubmed: 21367623
Stroke. 2013 Mar;44(3):870-947
pubmed: 23370205
Stroke. 2013 Jun;44(6):1601-5
pubmed: 23632974
Neurology. 2013 Aug 13;81(7):619-25
pubmed: 23864310
Health Technol Assess. 2014 Mar;18(16):1-176
pubmed: 24602782
Echocardiography. 2014 Oct;31(9):1036-48
pubmed: 24689727
Int J Stroke. 2015 Apr;10(3):282-91
pubmed: 25535808
J Am Soc Echocardiogr. 2016 Jan;29(1):1-42
pubmed: 26765302
Med Care. 2016 May;54(5):430-4
pubmed: 27075901
Neurology. 2016 Sep 6;87(10):988-95
pubmed: 27488602
Int J Cardiol. 2016 Nov 1;222:576-580
pubmed: 27513654
Cerebrovasc Dis Extra. 2016;6(3):96-106
pubmed: 27750249
Stroke. 2017 May;48(5):1226-1232
pubmed: 28381647
N Engl J Med. 2017 Sep 14;377(11):1033-1042
pubmed: 28902580
N Engl J Med. 2017 Sep 14;377(11):1022-1032
pubmed: 28902590
N Engl J Med. 2017 Sep 14;377(11):1011-1021
pubmed: 28902593
CMAJ Open. 2017 Dec 11;5(4):E842-E849
pubmed: 29237706
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
BMJ. 2018 Jul 25;362:k2515
pubmed: 30045912
BMJ Open. 2018 Jul 25;8(7):e023761
pubmed: 30049703
J Gen Intern Med. 2018 Nov;33(11):1899-1904
pubmed: 30054888
Circulation. 1997 Mar 18;95(6):1686-744
pubmed: 9118558