The Yield of Cardiac Investigations in Patients Presenting with an Acute Ischemic Stroke

Objectives: Strokes are a major source of morbidity and mortality. The Aim of this study was to evaluate the effectiveness of routine cardiac investigations in identifying a cardioembolic aetiology for ischemic strokes. Methods: This was a retrospective study of patients who had presented with a stroke to our institution between January and December 2019. Results: A total 183 patients (mean age 66.2+13.5 years, 109 or 59.6% male) were included in the final analysis. The common risk factors were hypertension (74.9%) diabetes (61.7%), and hyperlipidaemia (54.6%). The Middle cerebral artery (MCA) was the commonest artery affected (44 or 24%). On admission, 14(7.6%) patients were in atrial fibrillation with the rest being in sinus rhythm. On 24-hour ECG holter monitoring, no abnormalities were noted in 135 patients. Atrial fibrillation was seen in 15(8.1%) patients (inclusive of the 14 who had AF on resting ECG). 32 (17.4%) patients had evidence of non-sustained atrial arrhythmia and 9(4.9%) had non sustained ventricular tachycardia. Thirty patients(16.3%) were also noted to have frequent supraventricular ectopics (>30/hour) while 5(2.7%) patients had a high ventricular ectopic burden (>10% burden). No significant abnormalities were noted in the echocardiograms of the patients, but 10 out of 132 (7.5%) patients had a positive bubble echo. Twenty-four (13.1%) patients had enlarged left atria. Conclusion: The overall diagnostic yield of abnormalities from routine cardiac testing for patients with stroke appears to be low. Targeted screening of patients with crytogenic stroke as suggested by newer guidelines is recommended. 
Keywords: Cerebrovascular Accidents; Echocardiography; Atrial Fibrillation; Oman.