ABSTRACT NUMBER: ESOC2026A1753 THE ENIGMA OF THE MISSING ECHOCARDIOGRAPHY FOR PATIENTS WITH ISCHEMIC STROKE OF UNDETERMINED ETIOLOGY

Abstract Background and aims Acute ischemic stroke (AIS) of undetermined etiology (UE) is reported in one-third of patients. Current guidelines recommend assessment of these patients with an echocardiography to identify cardiac sources of cerebral embolism. The aim of this study was to determine the frequency and time to echocardiography in patients with stroke of UE compared to those with cardioembolic strokes (CES). Methods All patients with AIS assessed for recanalization therapy at our stroke center were consecutively included between June 7, 2024, and December 25, 2024. The etiologies were determined retrospectively using the TOAST-classification. The frequency of echocardiographies performed within 90 days, and the time to assessment were recorded. Analyses included chi-square and Wilcoxon-rank-sum tests. Statistical significance was defined as p<0.05. Results A total of 245 AIS patients were included, of these 91 had strokes of UE (median age 74 years, 45% female), and 61 had CES (median age 79 years, 56% female). The median NIHSS was lower for patients with UE compared to those with CES (5.5 versus 10, p<0.001). An echocardiography was performed in 27% of patients with strokes of UE versus 52% of patients with CES, p=0.003. The median time to first performed echocardiography was numerically longer for patients with UE (9 days, IQR:3-32) compared to those with CES (3 days, IQR:1-28.75), p=0.08. Conclusions Despite current recommendations, only one quarter of patients with strokes of UE had an echocardiography performed within 90 days compared to half of patients with CES, while the time to assessment was numerically longer. Conflict of interest Nicol Dara Matoor: Has received funding from the University Hospital of Copenhagen, Rigshospitalet, Research Foundation (E-24087-02), the funder had no role in the conduct of the study. Jonas Jalili Loft: nothing to disclose. Jørgen Tobias Kühl: nothing to disclose. Rasmus Holmboe Dahl: nothing to disclose. Annika Reynberg Langkilde: nothing to disclose. Klaus Kofoed: nothing to disclose. Thomas Truelsen: nothing to disclose.