title: Diagnostic yield and therapeutic impact of transthoracic echocardiography in patients with potential cardiac sources of cerebral embolism.
abstract: OBJECTIVE
  To explore the diagnostic yield of transthoracic echocardiography (TTE), and assess the effect of echocardiographic findings on subsequent therapy.
  
  
  METHODS
  In this retrospective study, we reviewed TTE reports and hospital records of patients diagnosed with a stroke or transient ischemic attack (TIA), screening for potential cardiac sources of embolism (CSE) from January 2006 to December 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia by considering at least 15 predefined TTE criteria. The therapeutic interventions employed as a consequence of the TTE findings were sought.
  
  
  RESULTS
  We analyzed 240 patients (mean patient age 58.514) out of 10563 TTEs. While only one patient exhibited a definite CSE on TTE, potential CSEs were found in 35 patients (14.6%), most commonly caused by left ventricular (LV) systolic dysfunction (31.4%), followed by LV regional wall motion abnormalities (25.7%). Multivariate analysis revealed 2 independent predictors for identifying a CSE on TTE: history of coronary artery disease (odds ratio [OR] 6.2, 95% confidence interval [CI]:2.6-14.8, p=0.0001), and nationality (OR 0.16, 95% CI: 0.3-0.7, p=0.019). The TTE findings affected therapy in only 3 patients (1.2%).
  
  
  CONCLUSIONS
  The TTE performed to exclude a CSE in patients with stroke or TIA resulted in low diagnostic yield, and had little impact on therapeutic decisions. Future refinement of clinical strategies to predict a CSE is needed to improve diagnosis, and possibly cost-effectiveness, of TTE.
authors.affiliation: Department of Cardiac Sciences, Cardiac Catheterization Lab, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. halfaleh@ksu.edu.sa
authors.forename: Hussam F
authors.initials: HF
authors.lastname: Al-Faleh
authors.forename: Amjad O
authors.initials: AO
authors.lastname: Al-Qadi
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Hersi
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies