Abstract Details

Title Evaluating the Diagnostic Power of Abnormal TTE in Cryptogenic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S41 - Sociodemographics of Stroke and Policy in Stroke Care (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Background Despite advances in medical technology, 20-30% of strokes are still classified as cryptogenic. A large portion of these strokes are presumed to be ESUS. Current AHA guidelines recommend (class IIb) advanced cardiac imaging in ESUS.

Objective To describe the sensitivity, specificity, and negative and positive predictive values of abnormal TTE for detection of intracardiac thrombus on advanced cardiac imaging, to better characterize factors likely to predict finding an abnormality on advanced cardiac imaging in cryptogenic strokes.

Design/Methods A retrospective review of stroke patients at a comprehensive stroke center who had cardiac CT or MRI between 12/2016 and 11/2020 was conducted using institutional registries. Ischemic stroke patients with cryptogenic etiologies were included. Cases with TIA, cardioembolic, large vessel, small vessel, or hemodynamic etiologies were excluded. TTE and cardiac CT/MRI results from all cases were reviewed for remarkable findings, most notably intracardiac thrombus, and presence of TTE abnormalities were analyzed. TTE abnormalities were defined as wall motion abnormalities, reduced LVEF <50%, and/or severe left atrial enlargement.

Results Two-hundred eighty-five cases (Female 45%, Caucasian 59%, Age mean: 64.4 years) were included, of whom 98 (34%) were cryptogenic and 187 (66%) were ESUS. Twelve (4.2%) revealed intracardiac thrombus, of which 9 had LV thrombus, 2 had LA thrombus, and 1 had RAA thrombus. Two were diagnosed with cardiac CT and 10 with cMRI. Of these, 10 had abnormal wall motion abnormalities on TTE, 6 had low LVEF, and 3 had severe left atrial enlargement. The sensitivity and specificity of abnormal TTE were 100% and 76.9% for an intracardiac thrombus. Abnormal TTE had a positive and negative predictive value of 16% and 100%.

Conclusions In this retrospective analysis of select stroke cases, abnormal TTE findings had high sensitivity in the detection of intracardiac thrombus on advanced cardiac imaging. A normal TTE had a high negative predictive value.

Authors/Disclosures
Matthew Yanus, MD (Methodist Hospital) PRESENTER	Dr. Yanus has nothing to disclose.
Angela P. Salemi, MD (Houston Methodist Neurology Department)	Dr. Salemi has nothing to disclose.
Tony J. Zhang, MD (Houston Methodist)	Dr. Zhang has nothing to disclose.
Riya Bhavsar, MD	Dr. Bhavsar has nothing to disclose.
Danish Kherani, MD	Dr. Kherani has nothing to disclose.
Himanshu A. Patel, MD (University of Maryland)	Dr. Patel has nothing to disclose.
Alan Pan	No disclosure on file
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.
Charles D. McCane (Houston Methodist)	Mr. McCane has nothing to disclose.
David Chiu, MD (Houston Methodist Hospital)	Dr. Chiu has nothing to disclose.
Rajan R. Gadhia, MD (Houston Methodist Hospital, WCMC)	Dr. Gadhia has nothing to disclose.
John J. Volpi, MD	Dr. Volpi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Volpi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for W.L. Gore. Dr. Volpi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Diamedica. Dr. Volpi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen. Dr. Volpi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Amgen. Dr. Volpi has received intellectual property interests from a discovery or technology relating to health care.
Tanu Garg, MD (Houston Methodist Hospital)	Dr. Garg has nothing to disclose.