Cardiological diagnostic work-up in stroke patients - a comprehensive study of test results and therapeutic implications

In some Western countries, many stroke patients undergo routine tests including ECG, echocardiography, carotid ultrasound and Holter monitoring, even though they have been shown to express limited value in unselected patients. Comprehensive data on yield of tests, especially on consequences taken from positive test results, are scanty. Consecutive stroke patients with evidence of ischaemic lesions by imaging techniques were included. Aetiology was determined using TOAST-classifications. Rates of positive test results and their impact on drug therapy, especially anticoagulation were evaluated. Two hundred and forty-one consecutive patients, age 69 +/- 13 years were included. Positive test results were documented in 19% with 12-lead ECG, 24% with carotid ultrasound, 24% with echocardiography and never with Holter monitoring. Overall, in 41% positive test results were present. Apart from echocardiography (37%), a change of therapy resulted in 51-56% of patients with a positive test result. Even though 12-lead ECG, carotid ultrasound and echocardiography only had relatively low incidences of positive findings, their impact on management in case of positive test results was quite high. Nevertheless, future studies to select patients more appropriately are needed. In contrast, Holter monitoring had no impact and should not be used in routine evaluation of stroke patients.