Usefulness of trans-thoracic echocardiography (TTE) in patients with acute ischaemic strokes and normal clinical cardiac examination

Introduction: Stroke is one of the leading causes of disability and mortality in Sri Lanka. Cardiac sources of embolism account for 15 - 30% of ischaemic strokes. For optimal treatment aiming at secondary prevention it is crucial to identify the source of the embolism.We aimed to assess the influence of routine echocardiography in the management of patients with ischaemic strokes who have no evidence of cardiac abnormality on routine medical history, physical examination or 12-lead ECG.

Methods: Transthoracic echocardiography (TTE) was performed in patients admitted to Professorial Medical Unit, Teaching Hospital Karapitiya with an acute ischaemic stroke and normal clinical cardiac evaluation including a 12-lead ECG. The echo findings were categorized as therapeutically significant or insignificant by the cardiologist who performed the echo and the treating physician.

Results: Of the 110 patients with acute ischaemic stroke with normal clinical cardiac evaluation, 14.5% had therapeutically significant echo findings; left ventricular systolic dysfunction with ejection fraction <35% in 13 (11.8%), left ventricular aneurysm with intraventricular clot in 2 (1.8%), and tight mitral stenosis in 1 (0.9%).