141 How Useful are Echocardiograms after Acute Stroke: Why, When, for Whom, What are the Results and How Does Echocardiography Influence Acute Stroke Unit Patients’ Treatment?

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Abstract

Introduction

Most modern Acute Stroke Services have a Local Guideline to indicate selection for Echocardiography. Nevertheless it is unknown who is selected and how the results influence Stroke patients’ management. In addition, there is wide variation of investigation and treatments in clinical practice and amongst Local and National Guidelines.

Method

Echocardiography for Acute Stroke Inpatients was audited including: selection compared to guidelines, type of patient, eg age, risk factors etc, timing and type of echocardiogram, results and management including referral for cardiological intervention, eg patent foramen ovale (PFO) closure.

Results

1195 Acute Stroke Unit inpatients were audited and 281 / 1195 (24%) received an echocardiogram (2010 to January 2013). For Stroke inpatients receiving echocardiography (149 women, 132 men, mean age 67 years),1 in 3[86 / 281 (31%)]had a significant echocardiographic finding likely to significantly influence future management, when left atrial enlargement was included. Even when an enlarged left atrium was excluded as significant, 1 in 5 [55 / 281 (20%)] still had a significant echocardiographic finding. 1 in10 [31 / 281 (11%)] had an enlarged left atrium alone without any other significant echocardiographic finding.1 in 20 [14 / 281 (4.9%)] had both a significant echocardiographic finding and an enlarged left atrium.51 (18%) received Contrast Bubble Echocardiography and 3 had PFO closure.

Conclusion

These findings are important in identifying Acute Stroke Unit Inpatients selected for echocardiography, what information is useful and how they are treated, in relation to local and national guidelines. 1 in 3 Stroke patients who received an echocardiogram had a significant finding that was likely to influence future management, when enlarged left atrium as included. 1 in 5 Stroke inpatients receiving echocardiography had a significant finding likely to alter management when left atrial enlargement was excluded. Echocardiography can provide useful information for a surprisingly high proportion of selected Acute Stroke Inpatients.

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