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Abstract Details

Transthoracic Echocardiography for Lacunar Strokes: Do We Need It in All Patients?
Cerebrovascular Disease and Interventional Neurology
P01 - (-)
234
BACKGROUND: TTE is extensively used for evaluation of causes for an acute lacunar stroke as part of the workup. The underlying pathology of Lacunar Strokes is microatheroma and Lipohyalinosis. Though, the efficacy of ECHO in cardio-embolic strokes is well proven, its usefulness in Lacunar Strokes is still debated.
DESIGN/METHODS: A retrospective chart review at 3 academic institutions in a single metropolitan area between May 2011 and December 2011 was performed. A total of 270 consecutive patients with clinical diagnosis of stroke were screened of which 56 patients met criteria for acute lacunar infarct (size <1.5 cm) based on MRI/CT findings. Demographics, risk factors and TTE results recorded. Primary outcome measures were LVH while secondary outcomes were CHF(EF<40%), presence of ASD/VSD and left ventricular thrombus.
RESULTS: Out of 270 patients, 56 (21%) met criteria for acute lacunar stroke. Average age was 56 years (卤8.5), 50% were male, 77% were African-American. In looking at risk factors for lacunar stroke, 79 % had hypertension, 34% had diabetes mellitus type 2 , 55% had hyperlipidemia, 61 % were smokers while 36% had a prior TIA or stroke. The mean NIHSS at admission was 3.5 (卤2.8), mean length of stay was 2.6 days (卤3.7) and approximately 2/3rds of the patients were discharged home. The incidence of LVH was 37.5%, while there was CHF in 1.8%. Of the patients with LVH, 91% were hypertensive and 33% were diabetic.
CONCLUSIONS: Left ventricular hypertrophy is considered sine qua non of hypertensive control, which is one of the major risk factors for lacunar stroke. In our series we did not find any intracardiac abnormality except for LVH which was almost exclusively in patients with hypertension. TTE adds to the stroke workup cost and should be used only in selected cases.
Authors/Disclosures
Kushak Suchdev, MD
PRESENTER 		Dr. Suchdev has nothing to disclose.
Rahul H. Damani, MD Dr. Damani has nothing to disclose.
Preet M. Varade, MD (Lehigh Valley Hospital - Cedar Crest) Dr. Varade has nothing to disclose.
Abhishek Singh, MD (Creighton School of Medicine/ CHI neurological institute) Dr. Singh has nothing to disclose.
Gregory Norris, MD (DetroitBrainInstitute) No disclosure on file
William W. Seeley, MD Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG Council. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global Consulting. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BridgeBio. Dr. Seeley has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Seeley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lyterian Therapeutics. The institution of Dr. Seeley has received research support from NIH. The institution of Dr. Seeley has received research support from Rainwater Charitable Foundation. The institution of Dr. Seeley has received research support from Bluefield Project to Cure FTD. The institution of Dr. Seeley has received research support from Chan-Zuckerberg Initiative.