Elsevier

International Journal of Cardiology

Volume 339, 15 September 2021, Pages 211-218
International Journal of Cardiology

Cardiac imaging in ischemic stroke or transient ischemic attack of undetermined cause: Systematic review & meta-analysis

https://doi.org/10.1016/j.ijcard.2021.06.047Get rights and content
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Highlights

  • Major cardioembolic sources are causes of ischemic stroke requiring therapy changes.

  • Patients with ischemic stroke of unknown cause often undergo echocardiography.

  • Only few studies report the yield of echocardiography in these patients.

  • Results show that echocardiography infrequently detects major cardioembolic sources.

Abstract

Background

Patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause often undergo cardiac imaging in search of a cardioembolic source. As the choice of the most appropriate imaging approach is controversial and therapeutic implications have changed over time, we aimed to identify in patients with “cryptogenic stroke or TIA” the yield of transthoracic or transesophageal echocardiography (TTE or TEE) and cardiac computed tomography (CT).

Methods and results

We performed a systematic review and meta-analysis according to the PRISMA guidelines. Included were studies that assessed consecutive patients with ischemic stroke or TIA of undetermined cause to evaluate the yield of TTE, TEE, or cardiac CT for detecting cardioembolic sources. For each type of cardioembolic source the pooled prevalence was calculated. Only six out of 1458 studies fulfilled the inclusion criteria (1022 patients). One study reported the yield of TTE, four of TEE, and one of both TTE and TEE; no study assessed cardiac CT. Mean patient age ranged from 44.3–71.2 years, 49.2–59.7% were male. TTE detected 43 cardioembolic sources in 316 patients (4 (1.3%) major, 39 (12.3%) minor), and TEE 248 in 937 patients (55 (5.9%) major, 193 (20.6%) minor). The most prevalent major cardioembolic source was left atrial appendage thrombus, yet results were heterogeneous among studies.

Conclusions

TTE and TEE infrequently detect major cardioembolic sources that require a change of therapy. Findings should be interpreted with caution due to the limited number of studies. A large-sized prospective clinical trial is warranted to support evidence-based decision-making.

Keywords

Cardiac emboli
Echocardiography
Transient ischemic attack
Ischemic stroke

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1

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation