Background/Aim: Current guidelines recommend transthoracic echocardiography (TTE) and ambulatory rhythm monitoring following ischemic stroke or transient ischemic attack (TIA) of undetermined cause for identifying cardioembolic sources (CES). Due to ongoing controversies about this routine strategy, we evaluated its yield in a real-world setting. Methods: In a tertiary medical center, we retrospectively evaluated consecutive patients with ischemic stroke or TIA of undetermined cause, who (after standard work-up) underwent TTE, ambulatory rhythm monitoring, or both. CES were classified as major if probably related to ischemic events and warranting a change of therapy. Results: Between January 2014 and December 2017, 674 patients had ischemic stroke or TIA of undetermined cause. Of all 484 patients (71.8%) who underwent TTE, 9 (1.9%) had a major CES. However, 7 of them had already been identified for cardiac evaluation due to new major electrocardiographic abnormalities or cardiac symptoms. Thus, only 2 patients (0.4%) truly benefitted from unselected TTE screening. Ambulatory rhythm monitoring was performed in 411 patients (61.0%) and revealed AF in 10 patients (2.4%). Conclusion: Detecting a major CES is essential because appropriate treatment lowers the risk of recurrent stroke. Nonetheless, in this real-world study that aimed at routine use of TTE and ambulatory rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause, the prevalence of major CES was low. Most patients with major CES on TTE already had an indication for referral to a cardiologist, suggesting that major CES might also have been identified with a much more selective use of TTE.
Cerebrovasc Dis Extra 2021;11:22–28

中文翻译：

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现实世界中不确定原因的缺血性中风或短暂性脑缺血发作患者的主要心脏栓塞来源检测

背景/目的：目前的指南建议在未确定原因的缺血性中风或短暂性脑缺血发作（TIA）后经胸超声心动图（TTE）和动态心律监测，以识别心脏栓塞源（CES）。由于有关此常规策略的争议不断，我们在实际环境中评估了其收益。方法：在一家三级医疗中心，我们回顾性评估了因病原因不明的缺血性卒中或TIA的连续患者，这些患者（在标准检查后）接受了TTE和/或动态监护。如果可能与缺血性事件有关并且需要改变治疗方法，则将CES分类为主要疾病。结果：在2014年1月至2017年12月之间，有674例患者的缺血性卒中或TIA病因未明。在所有接受TTE的484例患者中（71.8％），有9例（1.9％）患有CES。然而，由于新的主要心电图异常或心脏症状，已经确定其中7个用于心脏评估。因此，只有2名患者（0.4％）真正受益于未经选择的TTE筛查。对411名患者（61.0％）进行了动态心律监测，并在10名患者（2.4％）中发现了房颤。结论：检测主要CES是必不可少的，因为适当的治疗可降低中风复发的风险。尽管如此，在这项旨在对原因不明的缺血性卒中或TIA患者进行常规使用TTE和动态心律监测的现实研究中，主要CES的患病率较低。大多数在TTE上有CES的主要CES患者已经有转诊给心脏病专家的提示，这表明还可以通过选择TTE的更多选择来确定主要CES。
Cerebrovasc Dis Extra 2021; 11：22–28