Prepared by:
Oregon Health & Science University
Evidence-based Practice Center
Richard T. Meenan, Ph.D., M.P.H.
Principal Investigator
Somnath Saha, M.D., M.P.H.
Co-Principal Investigator
Roger Chou, M.D.
Karleen Swarztrauber, M.D., M.P.H.
Kathryn Pyle Krages, A.M.L.S., M.A.
Maureen O'Keefee-Rosetti, M.S.
Marian McDonagh, Pharm.D.
Benjamin K.S. Chan, M.S.
Mark C. Hornbrook, Ph.D.
Mark Helfand, M.D., M.P.H., EPC Director
Investigators
File Name Description Software Version File Size _______________________________________________________________________________________________________ 01front.doc Microsoft Word® Document MS Word® 2002 57KB 7 pages Contents: Front Cover, Title Page, Preface, Structured Abstract _______________________________________________________________________________________________________ 02conts.doc Microsoft Word® Document MS Word® 2002 36KB 3 pages Contents: Table of Contents _______________________________________________________________________________________________________ 03summ.doc Microsoft Word® Document MS Word® 2002 97KB 15 pages Contents: Summary: Overview, Reporting the Evidence, Methodology, Findings, Future Research _______________________________________________________________________________________________________ 04chap1.doc Microsoft Word® Document MS Word® 2002 144KB 8 pages Contents: Chapter 1. Introduction: Diagnostic Test Technology, Scope and Key Questions _______________________________________________________________________________________________________ 05chap2.doc Microsoft Word® Document MS Word® 2002 44KB 6 pages Contents: Chapter 2. Methods: Development of Key Questions, Technical Expert Advisory Group, Literature Search, Data Abstraction, Assessment of Study Quality, Synthesis of Evidence, Cost-Effectiveness Methods _______________________________________________________________________________________________________ 06tbl1.doc Microsoft Excel® Worksheet MS Excel® 2002 20KB 2 pages Contents: Table 1. Inclusion/exclusion criteria for studies _______________________________________________________________________________________________________ 07chap3.doc Microsoft Word® Document MS Word® 2002 868KB 42 pages Contents: Chapter 3. Results - Echocardiography: 1. Which clinically inapparent abnormalities identified by echocardiography among patients presenting with new ischemic brain syndrome represent risk factors recurrent stroke? 2. What is the yield of echocardiography in detecting potential sources of cardioembolism among patients with a new ischemic brain syndrome? 3. What are the operating characteristics (sensitivities, specificities, and likelihood rations) of transthoracic and transesophageal echocardiography in detecting potential sources of cardioembolic stroke? 4. What are the incidence and nature of complications associated with transesophageal echocardiography? 5. Are there clinically identifiable groups of patients with new ischemic brain syndrome who benefit from anticoagulation? 6. Are there echocardiographically identifiable groups of patients with new ischemic brain syndrome who benefit from anticoagulation? Cost Effectiveness of Echocardiography _______________________________________________________________________________________________________ 08fig1.doc Microsoft Word® Document MS Word® 2002 1.1MB 3 pages Contents: Figure 1. Summary receiver operating characteristic (ROC) curves for the diagnosis of intracardiac thrombus with echocardiography _______________________________________________________________________________________________________ 09fig2.doc Microsoft Word® Document MS Word® 2002 94KB 2 page Contents: Figure 2. Estimates of true and false positive test results for a hypothetical cohort of 1000 patients with stroke undergoing echocardiography for the detection of intracardiac thrombus: effect of varying prevalence estimates _______________________________________________________________________________________________________ 10fig3.doc Microsoft Word® Document MS Word® 2002 24KB 1 page Contents: Figure 3. Echocardiography decision tree _______________________________________________________________________________________________________ 11fig4.xls Microsoft Excel® Worksheet MS Excel® 2002 21KB 1 page Contents: Figure 4. Markov diagram--Post-treatment health states (echo model) _______________________________________________________________________________________________________ 12fig5.xls Microsoft Excel® Worksheet MS Excel® 2002 18KB 1 page Contents: Figure 5. Effect of Baseline Life Expectancy on Cost-Effectiveness of TEE in Patients with a History of Cardiac Disease (Cardiac History/TEE) _______________________________________________________________________________________________________ 13fig6.doc Microsoft Word® Document MS Word® 2002 62KB 1 page Contents: Figure 6. Cost-effectiveness of TEE as a function of 1) intracardiac thrombus prevalence, and 2) the relative risk (RR) of recurrent stroke with anticoagulation compared to aspirin (for patients with thrombus) _______________________________________________________________________________________________________ 14tbl2.doc Microsoft Word® Document MS Word® 2002 28KB 1 page Contents: Table 2. Potential sources of cardioembolic stroke _______________________________________________________________________________________________________ 15tbl3.doc Microsoft Word® Document MS Word® 2002 26KB 1 page Contents: Table 3. Evidence for independent association between clinically inapparent echocardiographic lesions and stroke _______________________________________________________________________________________________________ 16tbl4.doc Microsoft Word® Document MS Word® 2002 31KB 1 page Contents: Table 4. Echocardiography model testing strategies _______________________________________________________________________________________________________ 17tbl5.doc Microsoft Word® Document MS Word® 2002 31KB 1 page Contents: Table 5. Health state definitions with associated Rankin Disability Scale categories _______________________________________________________________________________________________________ 18tbl6.xls Microsoft Excel® Worksheet MS Excel® 2002 28KB 3 pages Contents: Table 6. Parameter List-Echocardiography _______________________________________________________________________________________________________ 19tbl7.xls Microsoft Excel® Worksheet MS Excel® 2002 16KB 1 page Contents: Table 7. Baseline echocardiography results _______________________________________________________________________________________________________ 20tbl8.xls Microsoft Excel® Worksheet MS Excel® 2002 58KB 4 pages Contents: Table 8. Sensitivity analyses--Echocardiography _______________________________________________________________________________________________________ 21chap4.doc Microsoft Word® Document MS Word® 2002 659KB 26 pages Contents: Chapter 4. Results - Carotid Imaging: 1. What are the operating characteristics of available tests for measuring carotid artery stenosis? 2. What is the incidence of complications associated with cerebral angiography? 3. What is the efficacy of carotid endarterectomy in reducing the rate of recurrent stroke among symptomatic patients with carotid artery stenosis? 4. What is the incidence of complications associated with carotid endarterectomy? 5. Does timing affect the safety of carotid endarterectomy? Cost-effectiveness of Carotid Imaging _______________________________________________________________________________________________________ 22fig7.doc Microsoft Word® Document MS Word® 2002 5.0MB 2 pages Contents: Figure 7. Summary receiver operating characteristic (ROC) curves for the diagnosis of carotid artery stenosis using carotid ultrasound (CUS), magnetic resonance angiography (MRA), or both _______________________________________________________________________________________________________ 23fig8.doc Microsoft Word® Document MS Word® 2002 24KB 1 page Contents: Figure 8. Carotid Imaging decision tree _______________________________________________________________________________________________________ 24fig9.xls Microsoft Excel® Worksheet MS Excel® 2002 19KB 1 page Contents: Figure 9. Markov diagram--Post-treatment health states (carotid model) _______________________________________________________________________________________________________ 25fig10.xls Microsoft Excel® Worksheet MS Excel® 2002 17KB 2 pages Contents: Figure 10. Effect of Baseline Life Expectancy on Cost-Effectiveness of MRA with Direct Referral of Patients with Severe (70-99 percent) Stenosis for CEA (MRA-70 percent) _______________________________________________________________________________________________________ 26fig11.doc Microsoft Word® Document MS Word® 2002 36KB 1 page Contents: Figure 11. Cost effectiveness of 1) CUS with Angiographic Confirmation for Severe (70-99 percent) Stenosis (CUS/Angio-70 percent), and 2) MRA with Direct Referral to CEA for Severe Stenosis (MRA-70 percent), as a Function of the Prevalence of Severe Stenosis _______________________________________________________________________________________________________ 27tbl9.doc Microsoft Word® Document MS Word® 2002 37KB 1 page Contents: Table 9. Pooled accuracy of carotid ultrasound _______________________________________________________________________________________________________ 28tbl10.doc Microsoft Word® Document MS Word® 2002 41KB 1 page Contents: Table 10. Pooled accuracy of magnetic resonance angiography _______________________________________________________________________________________________________ 29tbl11.doc Microsoft Word® Document MS Word® 2002 53KB 1 page Contents: Table 11. Aggregate operating characteristics of carotid ultrasound at maximal accuracy and varying diagnostic thresholds _______________________________________________________________________________________________________ 30tbl12.doc Microsoft Word® Document MS Word® 2002 34KB 1 page Contents: Table 12. Aggregate operating characteristics of magnetic resonance angiography at maximal accuracy and varying diagnostic thresholds _______________________________________________________________________________________________________ 31tbl13.doc Microsoft Word® Document MS Word® 2002 33KB 1 page Contents: Table 13. Aggregate operating characteristics of combined carotid ultrasound and magnetic resonance angiography at maximal accuracy and varying diagnostic thresholds _______________________________________________________________________________________________________ 32tbl14.xls Microsoft Excel® Worksheet MS Excel® 2002 17KB 1 page Contents: Table 14. Outcomes of diagnostic testing for carotid stenosis in 1000 hypothetical patients with stroke: effect of varying prevalence _______________________________________________________________________________________________________ 33tbl15.xls Microsoft Excel® Worksheet MS Excel® 2002 18KB 1 page Contents: Table 15. Perioperative (30-day) complication rates of carotid endarterectomy, stratified by study characteristics _______________________________________________________________________________________________________ 34tbl16.doc Microsoft Word® Document MS Word® 2002 37KB 1 page Contents: Table 16. Carotid imaging model testing strategies _______________________________________________________________________________________________________ 35tbl17.xls Microsoft Excel® Worksheet MS Excel® 2002 38KB 6 pages Contents: Table 17. Parameter List-Carotid Imaging _______________________________________________________________________________________________________ 36tbl18.xls Microsoft Excel® Worksheet MS Excel® 2002 17KB 1 page Contents: Table 18. Baseline carotid imaging results _______________________________________________________________________________________________________ 37tbl19.xls Microsoft Excel® Worksheet MS Excel® 2002 118KB 5 pages Contents: Table 19. Sensitivity analyses--Carotid imaging _______________________________________________________________________________________________________ 38chap5.doc Microsoft Word® Document MS Word® 2002 59KB 8 pages Contents: Chapter 5. Conclusions: Echocardiography, Carotid Imaging _______________________________________________________________________________________________________ 39tbl20.xls Microsoft Excel® Worksheet MS Excel® 2002 25KB 2 pages Contents: Table 20. Overall Quality and Summary of Evidence for Each Key Question _______________________________________________________________________________________________________ 40chap6.doc Microsoft Word® Document MS Word® 2002 26KB 2 pages Contents: Chapter 6. Recommendations for Future Research: Echocardiography, Carotid Imaging _______________________________________________________________________________________________________ 41refs.doc Microsoft Word® Document MS Word® 2002 127KB 17 pages Contents: References _______________________________________________________________________________________________________ 42etbl1.xls Microsoft Excel® Worksheet MS Excel® 2002 23KB 2 pages Contents: Evidence Table 1. Prevalence of Lesions Detected by Transthoracic Echocardiography in Patients with Stroke or TIA _______________________________________________________________________________________________________ 43etbl2.xls Microsoft Excel® Worksheet MS Excel® 2002 25KB 2 pages Contents: Evidence Table 2. Prevalence of Lesions Detected by Transesophageal Echocardiography in Patients with Stroke or TIA _______________________________________________________________________________________________________ 44etbl3.xls Microsoft Excel® Worksheet MS Excel® 2002 19KB 2 pages Contents: Evidence Table 3. Accuracy of Transesophageal Echocardiography for Detecting Left Atrial Thrombus _______________________________________________________________________________________________________ 45etbl4.xls Microsoft Excel® Worksheet MS Excel® 2002 19KB 2 pages Contents: Evidence Table 4. Accuracy of Transthoracic Echocardiography for Detecting Left Atrial Thrombus _______________________________________________________________________________________________________ 46etbl5.xls Microsoft Excel® Worksheet MS Excel® 2002 20KB 2 pages Contents: Evidence Table 5. Accuracy of Transthoracic Echocardiography for Detecting Left Ventricular Thrombus _______________________________________________________________________________________________________ 47etbl6.xls Microsoft Excel® Worksheet MS Excel® 2002 32KB 7 pages Contents: Evidence Table 6. Complications of transesophageal echocardiography _______________________________________________________________________________________________________ 48etbl7.xls Microsoft Excel® Worksheet MS Excel® 2002 30KB 4 pages Contents: Evidence Table 7. Efficacy and safety of anticoagulation in unselected patients with stroke _______________________________________________________________________________________________________ 49etbl8.xls Microsoft Excel® Worksheet MS Excel® 2002 25KB 4 pages Contents: Evidence Table 8. Accuracy of carotid ultrasound for detecting internal carotid artery stenosis _______________________________________________________________________________________________________ 50etbl9.xls Microsoft Excel® Worksheet MS Excel® 2002 24KB 4 pages Contents: Evidence Table 9. Accuracy of magnetic resonance angiography for detecting internal carotid artery stenosis _______________________________________________________________________________________________________ 51etbl10.xls Microsoft Excel® Worksheet MS Excel® 2002 33KB 9 pages Contents: Evidence Table 10. Accuracy of combined carotid ultrasound and magnetic resonance angiography for detecting internal carotid artery stenosis _______________________________________________________________________________________________________ 52etbl11.xls Microsoft Excel® Worksheet MS Excel® 2002 22KB 3 pages Contents: Evidence Table 11. Complications of cerebral angiography _______________________________________________________________________________________________________ 53etbl12.xls Microsoft Excel® Worksheet MS Excel® 2002 81KB 13 pages Contents: Evidence Table 12. Complications of carotid endarterectomy _______________________________________________________________________________________________________ 54etbl13.xls Microsoft Excel® Worksheet MS Excel® 2002 25KB 4 pages Contents: Evidence Table 13. Effect of timing on safety of carotid endarterectomy _______________________________________________________________________________________________________ 55biblio.doc Microsoft Word® Document MS Word® 2002 349KB 48 pages Contents: Bibliography _______________________________________________________________________________________________________ 56appa.doc Microsoft Word® Document MS Word® 2002 23KB 2 pages Contents: Appendix A. Abbreviations _______________________________________________________________________________________________________ 57appb.doc Microsoft Word® Document MS Word® 2002 47KB 5 pages Contents: Appendix B. Research Team, Technical Expert Advisory Group, and Peer Reviewers _______________________________________________________________________________________________________ 58appc.doc Microsoft Word® Document MS Word® 2002 100KB 18 pages Contents: Appendix C. Search Strategies _______________________________________________________________________________________________________ 59appd.ppt Microsoft PowerPoint® Presentation MS PowerPoint® 2002 37KB 1 page Contents: Appendix D. Search Results _______________________________________________________________________________________________________ 60appe.doc Microsoft Word® Document MS Word® 2002 32KB 3 pages Contents: Appendix E. Criteria for Grading Individual Studies _______________________________________________________________________________________________________ 61appf.pdf Adobe Acrobat® Document Adobe Acrobat® 3.02 256KB 34 pages Contents: Appendix F. Statistical Analysis Report for Effectiveness and Cost-effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke _______________________________________________________________________________________________________
AHRQ Publication No. 02-E022
Current as of July 2002
Internet Citation:
Effectiveness and Cost-Effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke. File Inventory, Evidence Report/Technology Assessment Number 49. AHRQ Publication No. 02-E022, July 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/stkmninv.htm
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