Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin.

Karl Georg Haeusler Christian Wollboldt Laura Zu Bentheim Juliane Herm Sebastian Jäger Claudia Kunze Holger-Carsten Eberle Claudia Christina Deluigi Oliver Bruder Carolin Malsch Peter U Heuschmann Matthias Endres Heinrich J Audebert Andreas J Morguet Christoph Jensen Jochen B Fiebach

Stroke

From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany (C.M., P.U.H.); Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany (A.J.M.); German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany (M.E.); and German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Germany (M.E.); and Berlin Institute of Health, Germany (M.E.).

Published: May 2017

Background And Purpose: Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up.

Methods: One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke.

Results: Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53-72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1-4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of κ=0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease.

Conclusions: Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01917955.

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http://dx.doi.org/10.1161/STROKEAHA.116.016227	DOI Listing

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