RT Journal Article
SR Electronic
T1 Frequency, predictors and cardiovascular outcomes associated with transthoracic echocardiographic findings during acute ischaemic stroke hospitalisation
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2021-001170
DO 10.1136/svn-2021-001170
A1 Richa Sharma
A1 Scott Silverman
A1 Shaun Patel
A1 Lee H Schwamm
A1 Danita Yoerger Sanborn
YR 2022
UL http://svn.bmj.com/content/early/2022/06/12/svn-2021-001170.abstract
AB Objective To characterise the clinical utility of transthoracic echocardiography (TTE) at the time of acute ischaemic stroke (AIS).Background The utility of obtaining a TTE during AIS hospitalisation is uncertain.Methods We studied AIS hospitalisations at a single centre (2002–2016). TTE abnormalities were classified as findings associated with: high stroke risk (Category I), cardiac events (Category II) and of unclear significance (Category III). We performed logistic regressions to predict Category I, II and III abnormalities. The odds of 1 year recurrent stroke hospitalisation captured by ICD 9 and 10 codes as a function of Category I, II and III abnormalities were assessed. Improvement in predictive capacity for 1 year recurrent ischaemic stroke hospitalisation beyond stroke risk factors was evaluated by net reclassification improvement.Results There were 5523 AIS hospitalisations. Nearly 81% of admission TTEs were abnormal (18.7% Category I, 32.7% Category II, 72.8% Category III). Older patients with coronary artery disease, atrial fibrillation, hypertension, diabetes, and patent intracranial and extracranial vessels were likely to have an abnormal TTE. Category I finding was associated with lower odds of 1-year recurrent stroke hospitalisation (OR 0.54, 95% CI 0.30 to 0.96). Category I data significantly improved the predictive value for 1-year recurrent ischaemic stroke hospitalisation beyond stroke risk factors (net reclassification improvement 0.1563, 95% CI 0.0465 to 0.2661).Conclusions TTE abnormalities associated with stroke and cardiac event risk were commonly detected during AIS hospitalisation. Detection of Category I TTE findings reduced the risk of recurrent stroke, potentially due to neutralisation of the cardioembolic source by targeted therapy, indicating the clinical utility of TTE.Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request by investigators.