title: Transthoracic echocardiographic findings in patients with acute retinal arterial obstruction. A retrospective review. Retinal Emboli of Cardiac Origin Group.
abstract: OBJECTIVE
  To assess the importance of cardio-embolic (emboli of cardiac origin) risk stratification in the cardiac evaluation of patients with acute retinal arterial obstruction.
  
  
  METHODS
  A multicenter retrospective study of patients with acute retinal arterial obstruction who underwent transthoracic echocardiography.
  
  
  METHODS
  Four North American hospital centers.
  
  
  METHODS
  One hundred patients with acute retinal artery obstruction in whom transthoracic echocardiography was performed.
  
  
  METHODS
  Anticoagulation or cardiac surgery based on abnormalities detected on transthoracic echocardiography. Transesophageal echocardiographic results were not evaluated, as they were rarely performed in our centers. Thus, the outcome measure was determined solely by the results of transthoracic echocardiography.
  
  
  RESULTS
  Patients were divided into high- and low-risk groups based on their history of cardioembolic risk factors or the presence of a cardiac murmur. Of 67 patients with no risk factors, 41 (61%) had normal echocardiographic study results and 26 (39%) had abnormalities detected, of whom only 1 (1.5%) received anticoagulation or cardiac surgery. The presence of 1 or more cardio-embolic risk factors increased the likelihood for anticoagulation or cardiac surgery 25 times (odds ratio = 25; 95% confidence interval = 3.04-217.02). Although this result is clinically and statistically significant, it is possible that abnormalities missed by transthoracic methods may have been detected by transesophageal technology.
  
  
  CONCLUSIONS
  In patients with acute retinal arterial obstruction at low cardioembolic risk, transthoracic echocardiography resulted in anticoagulation or cardiac surgery in 1 (1.5%) of 67 patients. Routine transthoracic echocardiography without follow-up transesophageal echocardiography for patients identified as having abnormalities such as left ventricular hypertrophy or mitral annular calcification and who are at low cardioembolic risk rarely resulted in anticoagulation or cardiac surgery.
authors.affiliation: Queen's University, Kingston, Ontario.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Naqvi
authors.forename: S M
authors.initials: SM
authors.lastname: Sharma
authors.forename: A F
authors.initials: AF
authors.lastname: Cruess
authors.forename: G C
authors.initials: GC
authors.lastname: Brown
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D004452:Echocardiography; D006801:Humans; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D013909:Thorax
chemical_list: D000925:Anticoagulants