Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie JR, Cohen DJ, Manning WJ, Douglas PS (Harvard Medical School, Harvard-Thorndike Laboratory, and Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA). Role of routine transthoracic echocardiography in evaluation and management of stroke. J Intern Med 1998; 243: 281–91. Objective To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease. Design The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years. Results Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality. Conclusion For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.