title: Diagnostic Yield of Echocardiography in Transient Ischemic Attack.
abstract: BACKGROUND
  Echocardiography is often performed to identify a cardiac source of embolism (CSE) causing transient ischemic attack (TIA). However, the diagnostic yield of echocardiography in TIA remains uncertain, and its role in routine evaluation of TIA is controversial.
  
  
  METHODS
  Patients with acute TIA were prospectively enrolled at 4 stroke centers. A CSE was defined using the Causative Classification of Stroke system; patent foramen ovale was considered a relevant CSE only if the patient underwent closure or was placed on anticoagulation. Patients with a known CSE at time of admission were excluded from analysis of the yield of echocardiography.
  
  
  RESULTS
  A total of 869 patients were enrolled at stroke centers, and 129 had a known CSE at presentation. Of the 740 remaining patients, 603 (81%) underwent echocardiography. A potential CSE was identified in 60 (10%) of these patients. The most common CSEs noted on echocardiography were complex aortic arch atherosclerosis and patent foramen ovale. History of coronary artery disease (P < .001), lack of prior stroke or TIA (P = .007), and presence of acute infarction on magnetic resonance imaging (MRI) (P < .001) were predictors of CSE on echocardiography. The yield of echocardiography was 29% in patients with both history of coronary artery disease and acute infarction on MRI, 14% with one of these features, and 5% with neither of these features (P < .0001). A CSE identified by echocardiography prompted initiation of anticoagulation in 15 of the 603 (2.5%) subjects.
  
  
  CONCLUSIONS
  Echocardiography demonstrates a relevant CSE in a significant portion of patients with TIA. However, changes in antithrombotic therapy resulting from echocardiography are infrequent.
authors.affiliation: Department of Neurology, University of Florida, Gainesville, Florida. Electronic address: Christina.Wilson@neurology.ufl.edu.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Wilson
authors.affiliation: Department of Neurology, Stanford University, Stanford, California.
authors.forename: Waimei
authors.initials: W
authors.lastname: Tai
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jamsheed A
authors.initials: JA
authors.lastname: Desai
authors.affiliation: Mater Misericordiae Hospital, Dublin, Ireland.
authors.forename: Ian
authors.initials: I
authors.lastname: Mulvihill
authors.affiliation: Department of Neurology, Stanford University, Stanford, California.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.affiliation: Mater Misericordiae Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Murphy
authors.affiliation: Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.affiliation: Department of Neurology, Stanford University, Stanford, California.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.affiliation: Mater Misericordiae Hospital, Dublin, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Brett L
authors.initials: BL
authors.lastname: Cucchiara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002170:Canada; D004452:Echocardiography; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D007494:Ireland; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: Echocardiography; aortic atheroma; cardioembolism; cardiomyopathy; patent foramen ovale (PFO); transient ischemic attack (TIA)