Transthoracic echocardiographic findings in patients with acute retinal arterial obstruction. A retrospective review. Retinal Emboli of Cardiac Origin Group
S. Sharma, A. Naqvi, S. M. Sharma, A. F. Cruess and G. C. Brown
Queen's University, Kingston, Ontario.
OBJECTIVE: To assess the importance of cardio-embolic (emboli of cardiac
origin) risk stratification in the cardiac evaluation of patients with
acute retinal arterial obstruction. DESIGN: A multicenter retrospective
study of patients with acute retinal arterial obstruction who underwent
transthoracic echocardiography. SETTINGS: Four North American hospital
centers. PATIENTS: One hundred patients with acute retinal artery
obstruction in whom transthoracic echocardiography was performed. MAIN
OUTCOME MEASURE: Anticoagulation or cardiac surgery based on abnormalities
detected on transthoracic echocardiography. Transesophageal
echocardiographic results were not evaluated, as they were rarely performed
in our centers. Thus, the outcome measure was determined solely by the
results of transthoracic echocardiography. RESULTS: Patients were divided
into high- and low-risk groups based on their history of cardioembolic risk
factors or the presence of a cardiac murmur. Of 67 patients with no risk
factors, 41 (61%) had normal echocardiographic study results and 26 (39%)
had abnormalities detected, of whom only 1 (1.5%) received anticoagulation
or cardiac surgery. The presence of 1 or more cardio-embolic risk factors
increased the likelihood for anticoagulation or cardiac surgery 25 times
(odds ratio = 25; 95% confidence interval = 3.04-217.02). Although this
result is clinically and statistically significant, it is possible that
abnormalities missed by transthoracic methods may have been detected by
transesophageal technology. CONCLUSIONS: In patients with acute retinal
arterial obstruction at low cardioembolic risk, transthoracic
echocardiography resulted in anticoagulation or cardiac surgery in 1 (1.5%)
of 67 patients. Routine transthoracic echocardiography without follow-up
transesophageal echocardiography for patients identified as having
abnormalities such as left ventricular hypertrophy or mitral annular
calcification and who are at low cardioembolic risk rarely resulted in
anticoagulation or cardiac surgery.
