IMPORTANCE OF TRANSTHORACIC AND TRANSOESOPHAGEAL ECHOCARDIOGRAPHY IN DECIDING SECONDARY THERAPEUTIC MANAGEMENT STRATEGIES IN STROKE PATIENTS.
Background. The cause of acute cerebrovascular infarction can be classified according to etiology with the TOAST-criteria. This classification subdivides the causes into; large-artery disease, cardioembolism, small-vessel disease, or stroke of unknown cause. Subdivision of stroke can also be done on the basis of the anatomical location of the lesion.
Transthoracic (TTE) and transoesophageal (TOE) echocardiography is widely used in diagnosing especially cardioembolic etiology behind acute cerebrovascular events. The use of these diagnostic tests varies between Norwegian hospitals. The recommendations however are that they should only be used when it will impact the type of treatment after the event. Patent foramen ovale, can be the cause of cardioembolic stroke through paradox embolism because it enables right to left intracardiac shunting.
The objective of our study was to clarify whether the use of TTE/TOE influences the therapeutic management strategies.
Methods. We have done a retrospective patient chart investigation of all patients who undervent TTE and/or TOE while admitted to Akershus Universitetssykehus with an acute cerebrovascular event, between 01.01.06 and 01.06.08.
We also recorded ECG-investigations, and ultrasound of brain supplying arteries in addition to patient risk factors.
Results. 161 out of a total ??? patients undervent echocardiography, 15% were found to have cardioembolism, 15% had large-vessel disease, 16% small-vessel disease, and 53% other unknown cause. 17% of the patients received warfarin, 80,1% received ASA as secondary prevention. 8,7% of the patients showed PFO og ASD, and 86% of these received ASA, while 29% received warfarin.
Interpretation. Our study demonstrates that even though TTE/TØE reveals only a small number of potential cardioembolic strokes, these diagnostic investigations influence the therapeutic strategies, and tends to lead to oral anticoagulation. TTE/TØE should therefore remain as a part of the diagnostic investigation of stroke patients.