The Use of Diagnostic Tests in Patients with Acute Ischemic Stroke

Prolonged Rhythm Monitoring for the Detection of Occult Paroxysmal Atrial Fibrillation in Ischemic Stroke of Unknown Cause

“…For inclusion, studies were required to fulfill the following criteria: (1) consecutive recruitment of stroke or TIA subjects, (2) cardiac monitoring to detect AF for a minimum duration of 12 hours; and (3) detection of new AF with the use of either a noninvasive or invasive cardiac monitoring device. We identified 19 studies (6 prospective and 13 retrospective) that assessed the ability of cardiac monitoring devices to identify AF in consecutive patients after ischemic stroke, [41][42][43][44][45] TIA, 46 or both [47][48][49][50][51][52][53][54][55][56][57][58][59] (Tables 2 and 3). The methods of cardiac monitoring in these studies were ambulatory ECG, 41 57,58 and implantable loop recorder.…”

“…53,55,56 The duration of cardiac monitoring also differed significantly across studies, from 24 hours to as long as 14 months. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] …”

“…44 -46,50,55,56,58 The duration of cardiac monitoring was reported in 13 studies and ranged from 22 hours to 14 months. 41,42,44,45,[47][48][49][53][54][55][56][57][58][59] Regardless of the detection method used, studies evaluating earlier monitoring reported a higher incidence of AF than those in which monitoring was pursued later. 54 Similarly, studies that monitored patients for a longer period identified a higher incidence of AF.…”

Echocardiography in the detection of cardioembolism in a stroke population

“…For this study, clinical cardiac disease was defined as in previous studies and included myocardial infarction, angina, arrhythmia, valvular heart disease, congestive heart failure or hypertension diagnosed on the basis of either history, physical examination, ECG or CXR. 4,7,11 Patients were graded from 0 to 4 according to the number of clinical factors that were positive (i.e. history, examination, ECG and/or CXR).…”

“…2,3 TTE has a diagnostic yield of between 4% and 10% in evaluating IS, whereas TOE has a yield of between 11% and 41%. [4][5][6][7][8] The variability depends largely on the presence or absence of clinical cardiac disease and the inclusion criteria used to define a clinically significant cardiac lesion.…”