AI Article Synopsis
- Cardiac CT may provide a new alternative to transthoracic echocardiography (TTE) for screening cardiac issues related to ischemic strokes, especially for detecting patent foramen ovale (PFO).
- In a study involving 59 patients under 60 years, cardiac CT identified PFO in only 8% of cases, while TTE detected it in 20%, highlighting the limited effectiveness of cardiac CT in this context.
- The low sensitivity of cardiac CT prompts the need for additional echocardiography in young patients with unexplained strokes, and more extensive research is necessary to validate these findings.
Article Abstract
Background: Cardiac CT acquired during the acute stroke imaging protocol is an emerging alternative to transthoracic echocardiography (TTE) to screen for sources of cardioembolism. Currently, its diagnostic accuracy to detect patent foramen ovale (PFO) is unclear.
Methods: This was a substudy of Mind the Heart, a prospective cohort in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during the initial stroke imaging protocol. Patients also underwent TTE. We included patients < 60 years who underwent TTE with agitated saline contrast (cTTE) and assessed sensitivity, specificity, negative and positive predictive value of cardiac CT for the detection of PFO using cTTE as the reference standard.
Results: Of 452 patients in Mind the Heart, 92 were younger than 60 years. Of these, 59 (64%) patients underwent both cardiac CT and cTTE and were included. Median age was 54 (IQR 49-57) years and 41/59 (70%) were male. Cardiac CT detected a PFO in 5/59 (8%) patients, 3 of which were confirmed on cTTE. cTTE detected a PFO in 12/59 (20%) patients. Sensitivity and specificity of cardiac CT were 25% (95% CI 5-57%) and 96% (95% CI 85-99%), respectively. Positive and negative predictive values were 59% (95% CI 14-95) and 84% (95% CI 71-92).
Conclusion: Prospective ECG-gated cardiac CT acquired during the acute stroke imaging protocol does not appear to be a suitable screening method for PFO due to its low sensitivity. Our data suggest that if cardiac CT is used as a first-line screening method for cardioembolism, additional echocardiography remains indicated in young patients with cryptogenic stroke, in whom PFO detection would have therapeutic consequences. These results need to be confirmed in larger cohorts.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10266986 | PMC |
| http://dx.doi.org/10.1007/s00415-023-11688-0 | DOI Listing |
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