We evaluated how often echocardiogram detected a potential cardiac source of embolism (CSE) in adults with acute ischemic stroke in Zambia.

Echocardiography is recommended in ischemic stroke work-up, yet its value in resource-limited settings ,where access is constrained, remains unclear.

A prospective cohort study was conducted from December 2019 to November 2024 at the University Teaching Hospital in Lusaka, Zambia, which enrolled patients with acute stroke. Data on medical history, diagnostic results, and treatment were collected. We calculated the proportion of patients with potential CSE on echocardiography, which was only obtained in those who could pay for this investigation.

Among 863 participants (mean age 60 ± 16 years; 465 [54%] female), 475 (55%) had ischemic stroke, 278 (32%) hemorrhagic stroke, and 110 (13%) unknown stroke type (i.e. no neuroimaging obtained). Echocardiograms were completed in 311 participants (36%), 208 of which were in participants with ischemic stroke. Among participants with ischemic stroke, potential CSEs were detected in 46 participants (22%): Ejection Fraction < 40% (n=35), atrial fibrillation (n=5), valvular heart disease (n=4), and thrombus/vegetation (n=2).

In this cohort, echocardiography detected a potential CSE in nearly one quarter of patients with ischemic stroke who obtained the test. Given the potential of CSE to change both acute management and long-term secondary prevention regimens, echocardiography is a potentially useful investigation in this setting. Efforts to improve access, including potentially bedside echocardiography, are needed to improve short- and long-term outcomes for people with ischemic strokes in this setting.