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Diagnostic Yield of Echocardiography in Transient Ischemic Attack
Background Echocardiography is often performed to identify a cardiac source of embolism (CSE) causing transient ischemic attack (TIA). However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial. Methods Patients with acute T...
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| Published in: | Journal of stroke and cerebrovascular diseases 2016-05, Vol.25 (5), p.1135-1140 |
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| creator | Wilson, Christina A., MD, PhD Tai, Waimei, MD Desai, Jamsheed A., MD, FRCPC Mulvihill, Ian, MBBCh Olivot, Jean-Marc, MD Murphy, Sean, MD Coutts, Shelagh B., MD, FRCPC Albers, Gregory W., MD Kelly, Peter, MD Cucchiara, Brett L., MD |
| description | Background Echocardiography is often performed to identify a cardiac source of embolism (CSE) causing transient ischemic attack (TIA). However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial. Methods Patients with acute TIA were prospectively enrolled at 4 stroke centers. A CSE was defined using the Causative Classification of Stroke system; patent foramen ovale was considered a relevant CSE only if the patient underwent closure or was placed on anticoagulation. Patients with a known CSE at time of admission were excluded from analysis of the yield of echocardiography. Results A total of 869 patients were enrolled at stroke centers, and 129 had a known CSE at presentation. Of the 740 remaining patients, 603 (81%) underwent echocardiography. A potential CSE was identified in 60 (10%) of these patients. The most common CSEs noted on echocardiography were complex aortic arch atherosclerosis and patent foramen ovale. History of coronary artery disease ( P |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2016.01.011 |
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However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial. Methods Patients with acute TIA were prospectively enrolled at 4 stroke centers. A CSE was defined using the Causative Classification of Stroke system; patent foramen ovale was considered a relevant CSE only if the patient underwent closure or was placed on anticoagulation. Patients with a known CSE at time of admission were excluded from analysis of the yield of echocardiography. Results A total of 869 patients were enrolled at stroke centers, and 129 had a known CSE at presentation. Of the 740 remaining patients, 603 (81%) underwent echocardiography. A potential CSE was identified in 60 (10%) of these patients. The most common CSEs noted on echocardiography were complex aortic arch atherosclerosis and patent foramen ovale. History of coronary artery disease ( P < .001), lack of prior stroke or TIA ( P = .007), and presence of acute infarction on magnetic resonance imaging (MRI) ( P < .001) were predictors of CSE on echocardiography. The yield of echocardiography was 29% in patients with both history of coronary artery disease and acute infarction on MRI, 14% with one of these features, and 5% with neither of these features ( P < .0001). A CSE identified by echocardiography prompted initiation of anticoagulation in 15 of the 603 (2.5%) subjects. Conclusions Echocardiography demonstrates a relevant CSE in a significant portion of patients with TIA. However, changes in antithrombotic therapy resulting from echocardiography are infrequent.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.011</identifier><identifier>PMID: 26915604</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; aortic atheroma ; California ; Canada ; cardioembolism ; cardiomyopathy ; Cardiovascular ; Echocardiography ; Embolism, Paradoxical - diagnostic imaging ; Embolism, Paradoxical - etiology ; Embolism, Paradoxical - prevention & control ; Female ; Fibrinolytic Agents - therapeutic use ; Heart Diseases - complications ; Heart Diseases - diagnostic imaging ; Heart Diseases - drug therapy ; Humans ; Intracranial Embolism - diagnostic imaging ; Intracranial Embolism - etiology ; Intracranial Embolism - prevention & control ; Ireland ; Ischemic Attack, Transient - diagnostic imaging ; Ischemic Attack, Transient - etiology ; Ischemic Attack, Transient - prevention & control ; Male ; Middle Aged ; Neurology ; patent foramen ovale (PFO) ; Pennsylvania ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Factors ; transient ischemic attack (TIA)</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2016-05, Vol.25 (5), p.1135-1140</ispartof><rights>National Stroke Association</rights><rights>2016 National Stroke Association</rights><rights>Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-3bbcdd77b5a4a4c0ca76b0ff3ce7671e392de0d4856c724c30f69ed7bec0306e3</citedby><cites>FETCH-LOGICAL-c459t-3bbcdd77b5a4a4c0ca76b0ff3ce7671e392de0d4856c724c30f69ed7bec0306e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26915604$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilson, Christina A., MD, PhD</creatorcontrib><creatorcontrib>Tai, Waimei, MD</creatorcontrib><creatorcontrib>Desai, Jamsheed A., MD, FRCPC</creatorcontrib><creatorcontrib>Mulvihill, Ian, MBBCh</creatorcontrib><creatorcontrib>Olivot, Jean-Marc, MD</creatorcontrib><creatorcontrib>Murphy, Sean, MD</creatorcontrib><creatorcontrib>Coutts, Shelagh B., MD, FRCPC</creatorcontrib><creatorcontrib>Albers, Gregory W., MD</creatorcontrib><creatorcontrib>Kelly, Peter, MD</creatorcontrib><creatorcontrib>Cucchiara, Brett L., MD</creatorcontrib><title>Diagnostic Yield of Echocardiography in Transient Ischemic Attack</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Background Echocardiography is often performed to identify a cardiac source of embolism (CSE) causing transient ischemic attack (TIA). However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial. Methods Patients with acute TIA were prospectively enrolled at 4 stroke centers. A CSE was defined using the Causative Classification of Stroke system; patent foramen ovale was considered a relevant CSE only if the patient underwent closure or was placed on anticoagulation. Patients with a known CSE at time of admission were excluded from analysis of the yield of echocardiography. Results A total of 869 patients were enrolled at stroke centers, and 129 had a known CSE at presentation. Of the 740 remaining patients, 603 (81%) underwent echocardiography. A potential CSE was identified in 60 (10%) of these patients. The most common CSEs noted on echocardiography were complex aortic arch atherosclerosis and patent foramen ovale. History of coronary artery disease ( P < .001), lack of prior stroke or TIA ( P = .007), and presence of acute infarction on magnetic resonance imaging (MRI) ( P < .001) were predictors of CSE on echocardiography. The yield of echocardiography was 29% in patients with both history of coronary artery disease and acute infarction on MRI, 14% with one of these features, and 5% with neither of these features ( P < .0001). A CSE identified by echocardiography prompted initiation of anticoagulation in 15 of the 603 (2.5%) subjects. Conclusions Echocardiography demonstrates a relevant CSE in a significant portion of patients with TIA. However, changes in antithrombotic therapy resulting from echocardiography are infrequent.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>aortic atheroma</subject><subject>California</subject><subject>Canada</subject><subject>cardioembolism</subject><subject>cardiomyopathy</subject><subject>Cardiovascular</subject><subject>Echocardiography</subject><subject>Embolism, Paradoxical - diagnostic imaging</subject><subject>Embolism, Paradoxical - etiology</subject><subject>Embolism, Paradoxical - prevention & control</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Heart Diseases - complications</subject><subject>Heart Diseases - diagnostic imaging</subject><subject>Heart Diseases - drug therapy</subject><subject>Humans</subject><subject>Intracranial Embolism - diagnostic imaging</subject><subject>Intracranial Embolism - etiology</subject><subject>Intracranial Embolism - prevention & control</subject><subject>Ireland</subject><subject>Ischemic Attack, Transient - diagnostic imaging</subject><subject>Ischemic Attack, Transient - etiology</subject><subject>Ischemic Attack, Transient - prevention & control</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>patent foramen ovale (PFO)</subject><subject>Pennsylvania</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>transient ischemic attack (TIA)</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqVkU2LFDEQhoMo7of-BemjCD1WOp2k-yKM664uDHjY3YOnkK5U76SnpzMmPQvz780wqwfxIhRUQR7eIk8x9oHDggNXH4fFkOYYNoQUqYvhySbn06LKbwvgufgLds6lqMpGcv4yzyCrUoDUZ-wipQEyIRv5mp1VquVSQX3Oll-8fZxCmj0WPzyNrgh9cY3rgDY6Hx6j3a0PhZ-K-2in5Gmai9uEa9pmfjnPFjdv2KvejonePvdL9nBzfX_1rVx9_3p7tVyVWMt2LkXXoXNad9LWtkZAq1UHfS-QtNKcRFs5Alc3UqGuahTQq5ac7ghBgCJxyd6fcncx_NxTms3WJ6RxtBOFfTJcN6Llqm3ajH4-oRhDSpF6s4t-a-PBcDBHlWYw_1JpjioN8Fw8h7x73rfvtuT-RPx2l4HVCaD86ydP0STMgpCcj4SzccH_375Pf8Xh6CePdtzQgdIQ9nHKfg03qTJg7o7HPd6WKwCoahC_ABI2qM0</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Wilson, Christina A., MD, PhD</creator><creator>Tai, Waimei, MD</creator><creator>Desai, Jamsheed A., MD, FRCPC</creator><creator>Mulvihill, Ian, MBBCh</creator><creator>Olivot, Jean-Marc, MD</creator><creator>Murphy, Sean, MD</creator><creator>Coutts, Shelagh B., MD, FRCPC</creator><creator>Albers, Gregory W., MD</creator><creator>Kelly, Peter, MD</creator><creator>Cucchiara, Brett L., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Diagnostic Yield of Echocardiography in Transient Ischemic Attack</title><author>Wilson, Christina A., MD, PhD ; Tai, Waimei, MD ; Desai, Jamsheed A., MD, FRCPC ; Mulvihill, Ian, MBBCh ; Olivot, Jean-Marc, MD ; Murphy, Sean, MD ; Coutts, Shelagh B., MD, FRCPC ; Albers, Gregory W., MD ; Kelly, Peter, MD ; Cucchiara, Brett L., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-3bbcdd77b5a4a4c0ca76b0ff3ce7671e392de0d4856c724c30f69ed7bec0306e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>aortic atheroma</topic><topic>California</topic><topic>Canada</topic><topic>cardioembolism</topic><topic>cardiomyopathy</topic><topic>Cardiovascular</topic><topic>Echocardiography</topic><topic>Embolism, Paradoxical - diagnostic imaging</topic><topic>Embolism, Paradoxical - etiology</topic><topic>Embolism, Paradoxical - prevention & control</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Heart Diseases - complications</topic><topic>Heart Diseases - diagnostic imaging</topic><topic>Heart Diseases - drug therapy</topic><topic>Humans</topic><topic>Intracranial Embolism - diagnostic imaging</topic><topic>Intracranial Embolism - etiology</topic><topic>Intracranial Embolism - prevention & control</topic><topic>Ireland</topic><topic>Ischemic Attack, Transient - diagnostic imaging</topic><topic>Ischemic Attack, Transient - etiology</topic><topic>Ischemic Attack, Transient - prevention & control</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>patent foramen ovale (PFO)</topic><topic>Pennsylvania</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>transient ischemic attack (TIA)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilson, Christina A., MD, PhD</creatorcontrib><creatorcontrib>Tai, Waimei, MD</creatorcontrib><creatorcontrib>Desai, Jamsheed A., MD, FRCPC</creatorcontrib><creatorcontrib>Mulvihill, Ian, MBBCh</creatorcontrib><creatorcontrib>Olivot, Jean-Marc, MD</creatorcontrib><creatorcontrib>Murphy, Sean, MD</creatorcontrib><creatorcontrib>Coutts, Shelagh B., MD, FRCPC</creatorcontrib><creatorcontrib>Albers, Gregory W., MD</creatorcontrib><creatorcontrib>Kelly, Peter, MD</creatorcontrib><creatorcontrib>Cucchiara, Brett L., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilson, Christina A., MD, PhD</au><au>Tai, Waimei, MD</au><au>Desai, Jamsheed A., MD, FRCPC</au><au>Mulvihill, Ian, MBBCh</au><au>Olivot, Jean-Marc, MD</au><au>Murphy, Sean, MD</au><au>Coutts, Shelagh B., MD, FRCPC</au><au>Albers, Gregory W., MD</au><au>Kelly, Peter, MD</au><au>Cucchiara, Brett L., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic Yield of Echocardiography in Transient Ischemic Attack</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>25</volume><issue>5</issue><spage>1135</spage><epage>1140</epage><pages>1135-1140</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Background Echocardiography is often performed to identify a cardiac source of embolism (CSE) causing transient ischemic attack (TIA). However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial. Methods Patients with acute TIA were prospectively enrolled at 4 stroke centers. A CSE was defined using the Causative Classification of Stroke system; patent foramen ovale was considered a relevant CSE only if the patient underwent closure or was placed on anticoagulation. Patients with a known CSE at time of admission were excluded from analysis of the yield of echocardiography. Results A total of 869 patients were enrolled at stroke centers, and 129 had a known CSE at presentation. Of the 740 remaining patients, 603 (81%) underwent echocardiography. A potential CSE was identified in 60 (10%) of these patients. The most common CSEs noted on echocardiography were complex aortic arch atherosclerosis and patent foramen ovale. History of coronary artery disease ( P < .001), lack of prior stroke or TIA ( P = .007), and presence of acute infarction on magnetic resonance imaging (MRI) ( P < .001) were predictors of CSE on echocardiography. The yield of echocardiography was 29% in patients with both history of coronary artery disease and acute infarction on MRI, 14% with one of these features, and 5% with neither of these features ( P < .0001). A CSE identified by echocardiography prompted initiation of anticoagulation in 15 of the 603 (2.5%) subjects. Conclusions Echocardiography demonstrates a relevant CSE in a significant portion of patients with TIA. However, changes in antithrombotic therapy resulting from echocardiography are infrequent.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26915604</pmid><doi>10.1016/j.jstrokecerebrovasdis.2016.01.011</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over aortic atheroma California Canada cardioembolism cardiomyopathy Cardiovascular Echocardiography Embolism, Paradoxical - diagnostic imaging Embolism, Paradoxical - etiology Embolism, Paradoxical - prevention & control Female Fibrinolytic Agents - therapeutic use Heart Diseases - complications Heart Diseases - diagnostic imaging Heart Diseases - drug therapy Humans Intracranial Embolism - diagnostic imaging Intracranial Embolism - etiology Intracranial Embolism - prevention & control Ireland Ischemic Attack, Transient - diagnostic imaging Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Male Middle Aged Neurology patent foramen ovale (PFO) Pennsylvania Predictive Value of Tests Prognosis Prospective Studies Risk Factors transient ischemic attack (TIA) |
| title | Diagnostic Yield of Echocardiography in Transient Ischemic Attack |
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