Association of Transthoracic Echocardiography Findings and Long-Term Outcomes in Patients Undergoing Workup of Stroke

Jeremy A. Miles, Leonid Garber, Subha Ghosh, Daniel M. Spevack

Research output: Contribution to journalArticle

Abstract

Background: Transthoracic echocardiography (TTE) has become routine as part of initial stroke workup to assess for sources of emboli. Few studies have looked at other TTE findings such as ejection fraction, wall motion abnormalities, valve disease, pulmonary hypertension and left ventricular hypertrophy and their association with various subtypes of stroke, long-term outcomes of recurrent stroke, and all-cause mortality. Methods and Results: Computed tomography and magnetic resonance imaging brain imaging and TTE reports were reviewed for 2464 consecutive patients referred for TTE as part of a workup for acute stroke between 1/1/01 and 9/30/07. Study patients were 67 ± 15 years, 60% female, 75% minorities and had hypertension (76%), diabetes (41%), chronic kidney disease (27%) and atrial fibrillation (18%). On TTE, a mass, thrombus, or vegetation was identified in only 4 cases (0.2%), whereas a clinically significant abnormality (ejection fraction < 50%, left ventricle or right ventricle wall motion abnormalities, severe valve disease, pulmonary hypertension, or left ventricular hypertrophy) was identified in 16%. Those with an abnormal TTE had increased risk for death at 10 years (hazard ratio [HR] 1.8; 95% confidence interval [CI]: 1.6, 2.0; P <.01), although risk for readmission with stroke was not increased. Abnormal TTE remained associated with increased risk of death at 10 years after adjustment for age, sex, race, and cardiovascular risk factors (HR 1.4; 95% CI: 1.2, 1.7; P <.01). Conclusions: TTE performed as part of an initial workup for stroke had minimal yield for identifying sources of embolism. Clinically important abnormalities found on TTE were independently associated with increased long-term mortality, but not recurrent stroke.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Jan 1 2018

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Echocardiography
Stroke
Left Ventricular Hypertrophy
Embolism
Pulmonary Hypertension
Heart Ventricles
Confidence Intervals
Mortality
Chronic Renal Insufficiency
Neuroimaging
Atrial Fibrillation
Thrombosis
Tomography
Magnetic Resonance Imaging
Hypertension

Keywords

  • long-term outcomes
  • mortality
  • Stroke
  • transthoracic echocardiography

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{c5896d87cb8745cdbb7840cd41a556de,
title = "Association of Transthoracic Echocardiography Findings and Long-Term Outcomes in Patients Undergoing Workup of Stroke",
abstract = "Background: Transthoracic echocardiography (TTE) has become routine as part of initial stroke workup to assess for sources of emboli. Few studies have looked at other TTE findings such as ejection fraction, wall motion abnormalities, valve disease, pulmonary hypertension and left ventricular hypertrophy and their association with various subtypes of stroke, long-term outcomes of recurrent stroke, and all-cause mortality. Methods and Results: Computed tomography and magnetic resonance imaging brain imaging and TTE reports were reviewed for 2464 consecutive patients referred for TTE as part of a workup for acute stroke between 1/1/01 and 9/30/07. Study patients were 67 ± 15 years, 60{\%} female, 75{\%} minorities and had hypertension (76{\%}), diabetes (41{\%}), chronic kidney disease (27{\%}) and atrial fibrillation (18{\%}). On TTE, a mass, thrombus, or vegetation was identified in only 4 cases (0.2{\%}), whereas a clinically significant abnormality (ejection fraction < 50{\%}, left ventricle or right ventricle wall motion abnormalities, severe valve disease, pulmonary hypertension, or left ventricular hypertrophy) was identified in 16{\%}. Those with an abnormal TTE had increased risk for death at 10 years (hazard ratio [HR] 1.8; 95{\%} confidence interval [CI]: 1.6, 2.0; P <.01), although risk for readmission with stroke was not increased. Abnormal TTE remained associated with increased risk of death at 10 years after adjustment for age, sex, race, and cardiovascular risk factors (HR 1.4; 95{\%} CI: 1.2, 1.7; P <.01). Conclusions: TTE performed as part of an initial workup for stroke had minimal yield for identifying sources of embolism. Clinically important abnormalities found on TTE were independently associated with increased long-term mortality, but not recurrent stroke.",
keywords = "long-term outcomes, mortality, Stroke, transthoracic echocardiography",
author = "Miles, {Jeremy A.} and Leonid Garber and Subha Ghosh and Spevack, {Daniel M.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jstrokecerebrovasdis.2018.06.023",
language = "English (US)",
journal = "Journal of Stroke and Cerebrovascular Diseases",
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TY - JOUR

T1 - Association of Transthoracic Echocardiography Findings and Long-Term Outcomes in Patients Undergoing Workup of Stroke

AU - Miles, Jeremy A.

AU - Garber, Leonid

AU - Ghosh, Subha

AU - Spevack, Daniel M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Transthoracic echocardiography (TTE) has become routine as part of initial stroke workup to assess for sources of emboli. Few studies have looked at other TTE findings such as ejection fraction, wall motion abnormalities, valve disease, pulmonary hypertension and left ventricular hypertrophy and their association with various subtypes of stroke, long-term outcomes of recurrent stroke, and all-cause mortality. Methods and Results: Computed tomography and magnetic resonance imaging brain imaging and TTE reports were reviewed for 2464 consecutive patients referred for TTE as part of a workup for acute stroke between 1/1/01 and 9/30/07. Study patients were 67 ± 15 years, 60% female, 75% minorities and had hypertension (76%), diabetes (41%), chronic kidney disease (27%) and atrial fibrillation (18%). On TTE, a mass, thrombus, or vegetation was identified in only 4 cases (0.2%), whereas a clinically significant abnormality (ejection fraction < 50%, left ventricle or right ventricle wall motion abnormalities, severe valve disease, pulmonary hypertension, or left ventricular hypertrophy) was identified in 16%. Those with an abnormal TTE had increased risk for death at 10 years (hazard ratio [HR] 1.8; 95% confidence interval [CI]: 1.6, 2.0; P <.01), although risk for readmission with stroke was not increased. Abnormal TTE remained associated with increased risk of death at 10 years after adjustment for age, sex, race, and cardiovascular risk factors (HR 1.4; 95% CI: 1.2, 1.7; P <.01). Conclusions: TTE performed as part of an initial workup for stroke had minimal yield for identifying sources of embolism. Clinically important abnormalities found on TTE were independently associated with increased long-term mortality, but not recurrent stroke.

AB - Background: Transthoracic echocardiography (TTE) has become routine as part of initial stroke workup to assess for sources of emboli. Few studies have looked at other TTE findings such as ejection fraction, wall motion abnormalities, valve disease, pulmonary hypertension and left ventricular hypertrophy and their association with various subtypes of stroke, long-term outcomes of recurrent stroke, and all-cause mortality. Methods and Results: Computed tomography and magnetic resonance imaging brain imaging and TTE reports were reviewed for 2464 consecutive patients referred for TTE as part of a workup for acute stroke between 1/1/01 and 9/30/07. Study patients were 67 ± 15 years, 60% female, 75% minorities and had hypertension (76%), diabetes (41%), chronic kidney disease (27%) and atrial fibrillation (18%). On TTE, a mass, thrombus, or vegetation was identified in only 4 cases (0.2%), whereas a clinically significant abnormality (ejection fraction < 50%, left ventricle or right ventricle wall motion abnormalities, severe valve disease, pulmonary hypertension, or left ventricular hypertrophy) was identified in 16%. Those with an abnormal TTE had increased risk for death at 10 years (hazard ratio [HR] 1.8; 95% confidence interval [CI]: 1.6, 2.0; P <.01), although risk for readmission with stroke was not increased. Abnormal TTE remained associated with increased risk of death at 10 years after adjustment for age, sex, race, and cardiovascular risk factors (HR 1.4; 95% CI: 1.2, 1.7; P <.01). Conclusions: TTE performed as part of an initial workup for stroke had minimal yield for identifying sources of embolism. Clinically important abnormalities found on TTE were independently associated with increased long-term mortality, but not recurrent stroke.

KW - long-term outcomes

KW - mortality

KW - Stroke

KW - transthoracic echocardiography

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U2 - 10.1016/j.jstrokecerebrovasdis.2018.06.023

DO - 10.1016/j.jstrokecerebrovasdis.2018.06.023

M3 - Article

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

ER -