title: Diagnostic yield of transthoracic echocardiography for stroke patients in a developing country.
abstract: OBJECTIVE
  To assess the utility and cost effectiveness of transthoracic echocardiography (TTE) as part of stroke workup in a developing country.
  
  
  METHODS
  All patients over the age of 14 years with acute stroke were prospectively enrolled in Aga Khan University stroke databank from August 1999 to May 2001 (22 month period). All patients were evaluated by a consultant neurologist and underwent standard stroke work up such as neuroimaging, TTE, carotid doppler sonography and blood tests e.g. serum glucose, lipid profile, blood urea nitrogen and serum creatinine. For the purpose of this study, patients with ischemic stroke were identified and their echocardiographic data was retrieved and analyzed. TOAST criteria was used to identify findings indicating cardioembolic stroke.
  
  
  RESULTS
  Ischaemic stroke was identified in 393 (76%) patients. Of these 278 (71%) patients underwent transthoracic echocardiography as part of stroke workup. Although 199 (73%) patients had abnormal echocardiogram; only 43 (15.5%) had findings suggestive of possible cardioembolism as defined by the TOAST criteria.
  
  
  CONCLUSIONS
  Tranthoracic echocardiography is a valid diagnostic modality for stroke workup. However there is a need to further investigate the specific indications which can be used to prioritize patients for undergoing echocardiography to minimize cost.
authors.affiliation: Department of Neurology, Aga Khan University Hospital, Karachi.
authors.forename: Muhib Alam
authors.initials: MA
authors.lastname: Khan
authors.forename: Bhojo
authors.initials: B
authors.lastname: Khealani
authors.forename: Bilal
authors.initials: B
authors.lastname: Hameed
authors.forename: Ayeesha
authors.initials: A
authors.lastname: Kamal
authors.forename: Mohammad
authors.initials: M
authors.lastname: Wasay
authors.forename: Nadir Ali
authors.initials: NA
authors.lastname: Syed
mesh_terms: D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics; D004617:Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D018579:Patient Selection; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology*