Abstract WP271: A Comparison of Bedside Echocardiography with Point of Care Ultrasound to Standard Transthoracic Echocardiography in the Setting of Acute Stroke and TIA

Abstract

Background: Transthoracic Echocardiography (TTE) is routinely performed in the setting of acute stroke and transient ischemic attack (TIA) to evaluate for a cardiac source of emboli. Although standard of care, guidelines remain ambiguous on the indications and recommendations for its routine use. Point-of-care ultrasound (POCUS), a quick bedside method of echocardiography using an easily portable, hand-held device, has been studied extensively in the ED, trauma, and ICU settings, but not for acute stroke and TIA. Here, we demonstrate the feasibility of using POCUS for the purpose of screening echocardiography in acute stroke & TIA patients. Additionally, we compare POCUS with TTE in order to evaluate the veracity of the point-of-care method with the gold standard. Methods: A retrospective comparison was made between routine TTE and POCUS results performed by a cardiologist during consultation. 99 patients were included, each admitted for workup of stroke, TIA, or retinal artery occlusions, and had a cardiology consultation for any reason. Parameters compared included left ventricular (LV) function, left atrial (LA) size, mitral valve (MV) and aortic valve (AV) pathology, and the presence of LA or LV thrombi, masses, or aneurysms. Results: All 16 cases with significant abnormalities (LV dysfunction, LV thrombi, or AV/MV vegetations) that were found on TTE were also identified by POCUS. Of the 13 patients with severely abnormal LV function on TTE, 12 were identified as severe on POCUS, and one as mild-moderate. Findings in 9 of these 16 patients led to a change in management, including one case where a large LV thrombus requiring a heparin infusion was identified hours earlier by POCUS. Conclusions: POCUS was comparable and non-inferior to the gold standard TTE for the purpose of screening echocardiography in the workup of acute ischemic stroke & TIA. Significant findings on TTE were all identified by a bedside POCUS (with the only discrepancy in the degree of LV dysfunction in a single case). All TTE findings resulting in management changes were also identified by POCUS. Importantly, POCUS can be used as a quick diagnostic screening tool to help establish an earlier diagnosis of life threatening conditions, and may lead to earlier management and treatment decisions.