Echocardiographic Findings in Patients with Transient Ischemic Attacks

Abstract

Echocardiography has a well-established utility for the detection of intramural thrombi and left atrial enlargement during routine evaluation of cerebrovascular accidents (CVA), however the use of echocardiography in transient ischemic attack (TIA) is much less established. Current guidelines from the American Heart Association (AHA)/American Stroke Association (ASA) recommend echocardiogram in ischemic stroke when cardioembolic source is suspected, but there is less clarity with regards to how results should be interpreted for ongoing patient care. We aimed to examine common echocardiogram findings in patients presenting with TIA. From 2018-2019, we examined all TIA patients over the age of 18 who were discharged from our comprehensive stroke center. Patients were excluded if they were diagnosed with acute stroke, demyelinating disease or intracranial mass found on MRI of the brain, or carotid stenosis greater than 50%. A total of 588 patients were identified and of these, 449 (76.36%) patients who met these criteria underwent transthoracic echocardiography (TTE) as part of their TIA evaluation. 130 (28.95%) of the 449 patients underwent echocardiogram with agitated saline. 2D echocardiogram reports were reviewed for the presence of left atrial size greater than 4 cm, atrial fibrillation, left ventricular thrombus, left atrial thrombus, moderate to severe mitral stenosis, patent foramen ovale, atrial septal defect, vegetation or mass on any valve, new left ventricle function less than 50%, and atrial myxoma. The overall incidence of mitral stenosis, patent foramen ovale (PFO), atrial septal defect (ASD), thrombus, atrial myxoma and vegetation was low and not statistically significant. PFO was discovered in 11 of the 130 (8.46%) agitated saline studies. The analysis showed that 173 of the 449 (38.53%) patients were found to have left atrial size greater than 4 cm. Of the patients with left atrial enlargement, 59 (34.10%) also carried a diagnosis of atrial fibrillation (AF) while 114 of the 173 (65.9%) did not. Ultimately, of patients without known AF, only 6 of 114 (5.25%) were discharged with cardiac monitoring. In summary, echocardiogram in TIA commonly demonstrates left atrial size greater than 4 cm, and only a very small proportion of patients with left atrial enlargement and no known history of atrial fibrillation were assigned to outpatient cardiac monitoring at the time of discharge.