The role of routine echocardiography in unselected patients with cerebrovascular ischaemic events.
BACKGROUND
Cardiac embolism is an important etiology of cerebrovascular ischaemic events (CIE). Echocardiography is routinely performed in patients with CIE despite guidelines recommending restriction of echocardiography to patients with clinically suspected cardioembolism.


OBJECTIVE
The aim of this study was to examine the therapeutic impact and prognostic role of echocardiographic findings in an unselected population suffering from CIE.


METHODS
Between November 2006 and November 2007, 319 patients with CIE underwent evaluation by transthoracic echocardiography (TTE) and in addition by transesophageal echocardiography (TEE) if deemed mandatory (n = 49). The combined clinical end-point included death or recurrent CIE, occurring during a follow-up period of 3 and 12 months, respectively.


RESULTS
After 3 months of follow-up, the combined end-point was noted in 30 (9%) and after 12 months in 43 (13%) patients. In multivariate analysis, atrial fibrillation (AF) (HR 2.12, 95% CI 1.38-3.25; P < 0.001) and coronary artery disease (CAD: HR 1.85, 95% CI 1.21-2.81; P = 0.004) were predictors of events occurring during short-term follow-up. After 1 year of follow-up, AF (HR 1.67, 95% CI 1.19-2.32; P = 0.003) and CAD (HR 1.5, 95% CI 1.09-2.06; P = 0.01) were associated with the combined end-point. Echocardiographic parameters assessed at study entry were not independently related to an adverse outcome.


CONCLUSIONS
Whereas AF and CAD appear to increase the risk of events after suffering from CIE, echocardiographic findings were not independently associated with the combined end-point of recurrent CIE or death.
Wachter
M
M
Department of Cardiology, University Hospital Basel, Switzerland.
Katan
M
M
Muzzarelli
S
S
Rohner
A
A
Christ-Crain
M
M
Fluri
F
F
Bernheim
A M
AM
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D023381:Endpoint Determination / Q000379:methods; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods