Objective:

To assess the effectiveness of routine transthoracic echocardiography (TTE) in stroke management in a low-resource setting.

Background:

A TTE is a key investigation in stroke evaluation. Evidence on the utility of  routine TTE in stroke workup is heavily skewed towards resource-rich settings. Whether or
not its routine use can lead to clinically actionable findings that can improve patient outcomes in ischemic stroke or transient ischemic attack in low-resource settings is unclear.

Design/Methods:

We conducted a cross-sectional study with stroke patients from two stroke units in Senegal.
Transthoracic echocardiograms were done on patients presenting with either ischemic stroke or transient ischemic attack (TIA) as standard first-line tests for stroke evaluation. We assessed the proportion of patients with TTE findings that altered management and assessed the impact on patient outcomes.

Results:

We enrolled a total of 479 stroke patients, with 83.7% (401/479) confirmed ischemic stroke and
16.3% (78/479) transient ischemic attack. Of all the TTEs assessed, 78.2% were normal or revealed no
clinically actionable findings. TTE findings altered management in 22.8% of patients by identifying
rheumatic valvular heart disease (54.1%), dilated cardiomyopathy (24.1%), intracardiac thrombus (8.4%), and ischemic heart disease (7.2%). There was no statistically significant improvement in Modified Rankin scores at discharge for patients with clinically actionable findings. A younger age (≤50 years) was significantly associated with clinically actionable findings.

Conclusions:

While TTE is a valuable tool in stroke evaluation, in low-resource settings where patients’ financial resources are often limited, our results suggest that routine use of TTEs as part of standard first-line test in ischemic stroke or TIA should be reconsidered. Rigorous selection of patients for TTE will ensure that limited resources are allocated efficiently and effectively.