title: A comparison of two-dimensional echocardiography vs carotid duplex scanning in older patients with cerebral ischemia.
abstract: BACKGROUND
  To determine the relative value of two-dimensional (2D) echocardiography vs carotid duplex scanning and to devise an optimal, cost-effective diagnostic approach for older patients with cerebral ischemia, 68 consecutive patients in sinus rhythm who suffered focal cerebral ischemia were studied. All patients underwent 2D echocardiography and carotid duplex scanning in addition to routine clinical evaluation.
  
  
  METHODS
  Twenty-five of 68 patients had Q-wave myocardial infarction by electrocardiography; nine (36%) of these 25 had left ventricular mural thrombi demonstrated by 2D echocardiography. In contrast, none of 43 patients without Q-wave myocardial infarction had clinically unsuspected findings diagnosed by 2D echocardiography. Duplex scanning, however, identified significant, abnormal findings in the carotid artery ipsilateral to the involved cerebral hemisphere in 23 patients (34%).
  
  
  CONCLUSIONS
  Thus, in older patients in sinus rhythm who suffer a cerebral ischemic event, carotid duplex scanning has a higher diagnostic yield than 2D echocardiography and appears to be a more cost-effective initial test. Our data suggest that in patients with carotid distribution cerebral ischemic events and no obvious cardiac source for emboli by history and physical examination, 2D echocardiography should be limited to those with evidence of Q-wave myocardial infarction by electrocardiography; such management should optimize diagnostic yield and cost effectiveness.
authors.affiliation: Department of Medicine, University of Massachusetts Medical Center, Worcester 01655.
authors.forename: S J
authors.initials: SJ
authors.lastname: Voyce
authors.forename: G P
authors.initials: GP
authors.lastname: Aurigemma
authors.forename: S
authors.initials: S
authors.lastname: Dahlberg
authors.forename: D
authors.initials: D
authors.lastname: Orsinelli
authors.forename: L A
authors.initials: LA
authors.lastname: Pape
authors.forename: A
authors.initials: A
authors.lastname: Sweeney
authors.forename: P
authors.initials: P
authors.lastname: Cardullo
authors.forename: L
authors.initials: L
authors.lastname: Recht
mesh_terms: D000368:Aged; D000465:Algorithms; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging*