Abstract WP204: The Advantage of the Routine

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Abstract

Introduction: Cardioembolic (CE) stroke is the most devastating type of ischemic stroke. Prior research has focused on choice of monitoring for occult tachyarrhythmia, but earlier identification of cardiac anatomical dysfunction, utilizing routine transthoracic echocardiogram (TTE), may expedite appropriate management.

Methods: All inpatients admitted to Johns Hopkins Hospital from 7/1/13-7/1/15 with imaging-confirmed ischemic stroke with a TTE within 7 days of admission were included. TTE reports were reviewed for structural features as well as systolic/diastolic function. Stroke subtype (CE vs. other) was defined using TOAST criteria, blinded to echo data. CE stroke was the outcome of interest using multivariable logistic regression to test the association with TTE structural measurements after adjusting for potential confounders.

Results: 443 patients met inclusion criteria. CE strokes (N=123) did not significantly differ from other stroke subtypes by age/gender but did by race (black 46% v 57%) and stroke severity (NIHSS≈8 v 5). In adjusted models, odds of CE significantly increased with increasing left atrial systolic diameter, Mitral E point velocity, decreasing ejection fraction, absence of mitral annular calcification and presence of mitral valve dysfunction or wall motion abnormality (Table 1).

Conclusions: Further understanding the relationship between TTE markers of cardiac structure and function and stroke subtype could potentially impact clinical practice, as TTE data are currently underused in the consideration of stroke mechanism and management. Confirmation of the reported associations, using more advanced imaging techniques, would enable more meaningful interpretation of these parameters, thereby leading to early initiation of medical management (anticoagulation) or further workup (event monitors).

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