ABSTRACT NUMBER: ESOC2026A1881 EVALUATING THE UTILITY OF ECHOCARDIOGRAM IN THE DIAGNOSTIC WORK UP OF STROKE PATIENTS IN RESOURCE-LIMITED SETTINGS

Abstract Background and aims Echocardiography is recommended in ischemic stroke work up, yet its value in resource limited settings where access is constrained remains unclear. We evaluated how often echocardiogram detected a potential cardiac source of embolism (CSE) in adults with acute ischemic stroke in Zambia. Methods A prospective cohort study was conducted from December 2019 to November 2024 at the University Teaching Hospital in Lusaka, Zambia, which enrolled patients with acute stroke. Data on medical history, diagnostic results, and treatment were collected. We calculated the proportion of patients with potential CSE on echocardiography, which was only obtained in those who could pay for this investigation. Results Among 863 participants (mean age 60 ± 16 years; 465 [54%] female), 475 (55%) had ischemic stroke, 278 (32%) hemorrhagic stroke, and 110 (13%) unknown stroke type (i.e. no neuroimaging obtained). Echocardiograms were completed in 311 participants (36%), 208 of which were in participants with ischemic stroke. Among participants with ischemic stroke, potential CSEs were detected in 46 participants (22%): Ejection Fraction < 40% (n=35), atrial fibrillation (n=5), valvular heart disease (n=4), and thrombus/vegetation (n=2). Conclusions In this cohort, echocardiography detected a potential CSE in nearly one quarter of patients with ischemic stroke who obtained the test. Given the potential of CSE to change both acute management and long-term secondary prevention regimens, echocardiography is a potentially useful investigation in this setting. Efforts to improve access, including potentially through bedside echocardiography, are needed to improve short- and long-term outcomes for people with ischemic strokes in this setting. Conflict of interest This study was funded by National Institutes of health (NIH) and it was submitted to the American academy of Neurology 2026 April Conference.