Background Echocardiography (Echo) is frequently utilized as part of the work up for ischemic stroke. National guidelines suggest using echo to assess for source of unexplained stroke “if detection of a structural cardiac abnormality would prompt a change of management”. This study aims to describe the use of Echocardiography post-stroke in Mayo University Hospital (MUH). Methods The study population was derived from a list of strokes admitted to MUH from July to December 2023 which was compiled by the Stroke ANP. The radiology system was consulted to assess time to echo and findings. Results 86 ischemic strokes were identified. 77 (89%) had echocardiography ordered as inpatient. 61 of 77 echoes ordered were filmed during admission. The mean wait for echo was 6.4 days. No PFO or LV thrombus was detected. In 52% (n=32) of echo’s performed for work up of aetiology of stroke there was no mention of intra-atrial septum (IAS) in the report. 24% had Modified Rankin Scale on discharge of 4 or above. Of these, 75% had echo ordered as inpatient despite 60% already having atrial fibrillation diagnosed. Conclusion Echocardiography appeared to be an over-utilised resource in ischemic strokes in MUH. The vast majority of patients with stroke, even if frail, elderly, or severely disabled, had echocardiography ordered despite national guidelines suggesting usage of echo only when diagnosis of structural heart disease was likely to change management. The intra-atrial septum wasn’t even mentioned in the majority of studies. The wait for echocardiography appears to be extending bed days for patients putting strain on hospital inpatient capacity and emergency departments. A more nuanced approach to ordering echo in the setting of acute stroke could be advocated for, this will take a collaborative effort between Cardiology and Stroke Medicine in order to prioritise that will most benefit from this precious resource.

中文翻译：

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急性中风的超声心动图 - 宝贵的资源


背景 超声心动图 (Echo) 经常被用作缺血性中风检查的一部分。国家指南建议使用回声来评估不明原因中风的来源，“如果检测到结构性心脏异常会促使改变治疗方法”。本研究旨在描述梅奥大学医院 (MUH) 中风后超声心动图的使用情况。方法 研究人群来源于 2023 年 7 月至 12 月 MUH 收治的中风清单，该清单由中风 ANP 编制。咨询放射学系统以评估回波时间和结果。结果发现 86 例缺血性中风。 77 名（89%）住院患者接受了超声心动图检查。所订购的 77 次回波中有 61 次是在入院期间拍摄的。等待 echo 的平均时间为 6.4 天。未检测到 PFO 或左心室血栓。在 52% (n=32) 进行中风病因学检查的回波中，报告中没有提及房间隔 (IAS)。 24% 出院时改良兰金量表为 4 或以上。其中，75% 的人作为住院患者接受了超声检查，尽管 60% 的人已经诊断出心房颤动。结论 超声心动图似乎是 MUH 缺血性卒中的一种过度利用的资源。尽管国家指南建议仅在诊断出结构性心脏病可能改变治疗时才使用超声心动图，但绝大多数中风患者，即使是体弱、年老或严重残疾，也需要进行超声心动图检查。大多数研究甚至没有提到房间隔。等待超声心动图检查似乎延长了患者的住院时间，给医院住院容量和急诊科带来了压力。 可以提倡在急性中风的情况下采用更细致的回声排序方法，这需要心脏病学和中风医学之间的合作，以便优先考虑最能从这一宝贵资源中受益的方面。