title: Should transesophageal echocardiography be performed in acute stroke patients with atrial fibrillation?
abstract: The diagnostic need for echocardiography in acute stroke patients with documented atrial fibrillation (AF) is controversial because the index stroke per se is an indication for therapeutic anticoagulation according to guidelines. We retrospectively analyzed medical records of 2390 stroke patients consecutively admitted over a 2-year period to three different stroke units at university hospitals in Berlin, Germany. AF was diagnosed in 21.2% (n=506) of 2185 patients with acute ischemic stroke or transient ischemic attack. Overall, 36.6% (n=185) of all AF patients underwent transesophageal echocardiography (TEE) or transthoracic echocardiography within days of hospital admission. According to multivariate analysis, age and in-hospital conventions determined the diagnostic use of TEE in stroke patients with known AF, while the existing cardiovascular risk profile had no impact. Major cardiac sources of embolism were identified by echocardiography in 9.7% (n=18) of all AF patients with acute stroke, including non-AF-related sources of embolism in 3.8% (n=7). However, echocardiographic findings did not result in any therapeutic intervention other than immediate anticoagulation. Furthermore, echocardiographic findings had no impact on the prescription of anticoagulants at hospital discharge or long-term survival. Taken together, our data indicate that diagnostic echocardiography offers only a little additional information and does not impact clinical management and outcome in acute stroke patients with known AF.
authors: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Juliane
authors: J
authors: Herm
authors: Maria
authors: M
authors: Konieczny
authors: Gerhard Jan
authors: GJ
authors: Jungehulsing
authors: Matthias
authors: M
authors: Endres
authors: Arno
authors: A
authors: Villringer
authors: Uwe
authors: U
authors: Malzahn
authors: Peter U
authors: PU
authors: Heuschmann
authors: Karl Georg
authors: KG
authors: Haeusler
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging*; D019090:Case Management; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D013534:Survival
chemical_list: D000925:Anticoagulants