TRANSTHORACIC ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH ACUTE RETINAL ARTERIAL-OBSTRUCTION - A RETROSPECTIVE REVIEW

Objective: To assess the importance of cardio-embolic (emboli of cardi ac origin) risk stratification in the cardiac evaluation of patients w ith acute retinal arterial obstruction. Design: A multicenter retrospe ctive study of patients with acute retinal arterial obstruction who un derwent transthoracic echocardiography. Settings: Four North American hospital centers. Patients: One hundred patients with acute retinal ar tery obstruction in whom transthoracic echocardiography was performed. Main Outcome Measure: Anticoagulation or cardiac surgery based on abn ormalities detected on transthoracic echocardiography. Transesophageal echocardiographic results were not evaluated, as they were rarely per formed in our centers. Thus, the outcome measure was determined solely by the results of transthoracic echocardiography. Results: Patients w ere divided into high- and low-risk groups based on their history of c ardioembolic risk factors or the presence of a cardiac murmur. Of 67 p atients with no risk factors, 41 (61%) had normal echocardiographic st udy results and 26 (39%) had abnormalities detected, of whom only 1 (1 .5%) received anticoagulation or cardiac surgery. The presence of 1 or more cardioembolic risk factors increased the likelihood for anticoag ulation or cardiac surgery 25 times (odds ratio=25; 95% confidence int erval=3.04-217.02). Although this result is clinically and statistical ly significant, it is possible that abnormalities missed by transthora cic methods may have been detected by transesophageal technology. Conc lusions: In patients with acute retinal arterial obstruction at low ca rdioembolic risk, transthoracic echocardiography resulted in anticoagu lation or cardiac surgery in 1 (1.5%) of 67 patients. Routine transtho racic echocardiography without follow-up transesophageal echocardiogra phy for patients identified as having abnormalities such as left ventr icular hypertrophy or mitral annular calcification and who are at low cardioembolic risk rarely resulted in anticoagulation or cardiac surge ry.