Transesophageal echocardiography screening in subjects with a first cerebrovascular ischemic event.
Our goal was to develop decision guides to predict the presence of a high-risk source of embolus and to predict a change in management following transesophageal echocardiography (TEE) in subjects who present with a first cerebral ischemic event. We conducted a retrospective review of subjects age ≥18 years who underwent TEE after a first ischemic event and were admitted to our stroke service between 2004 and 2007 (n = 287). A high-risk source of embolus and a change in clinical management (including medication changes or subsequent testing) were analyzed as separate endpoints, using multivariate techniques and receiver operating characteristic curves. We found that 14.3% of the subjects had a high-risk source, and an additional 61.3% had a potential (or low-risk) source of embolus. Increasing age and no history of diabetes mellitus were independently associated with a high-risk source of embolus. TEE would be recommended for nondiabetic individuals age ≥66 years (sensitivity, 68%; specificity, 76%). The area under the curve (AUC) for detecting a high-risk source was 0.773. TEE results changed medications or clinical management in 30.3% of the subjects. Current smokers were less likely to undergo a change in management. The AUC was uninformative (0.56) for predicting changes in management. Subjects presenting with a first ischemic event age ≥66 years may benefit from TEE. Although changes in management occurred in at least 30% of our cohort, no factors that predicted a change in management better than chance alone could be identified.
Young
Kate C
KC
Department of Neurology, University of Rochester Medical Center, 575 Elmwood Ave., Rochester, NY 14620, USA. kate_young@urmc.rochester.edu
Benesch
Curtis G
CG
D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009518:New York; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
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