Heart-brain interactions in cerebral ischaemia: a non-invasive cardiologic study protocol
Related Experiment Video
Updated: Nov 8, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
S Urbinati1, G Di Pasquale, A Andreoli
1Division of Cardiology, Bellaria Hospital, Bologna, Italy.
Insights
A systematic cardiologic evaluation is crucial for patients with cerebral ischemia to identify cardiac sources of emboli and coexisting heart disease. Non-invasive screening, including exercise ECG and myocardial scintigraphy, is recommended for early detection and management.
Area of Science:
- Cardiology
- Neurology
- Diagnostic Imaging
Background:
- Cerebral ischemia necessitates cardiologic evaluation to detect potential embolic sources and asymptomatic ischemic heart disease.
- A ten-year study systematically evaluated cardiac conditions in patients admitted for cerebral ischemia.
Purpose of the Study:
- To assess the utility of non-invasive cardiologic evaluations in patients with cerebral ischemia.
- To identify cardiac abnormalities, including potential sources of cerebral emboli and underlying ischemic heart disease.
Main Methods:
- Two-dimensional echocardiography performed on 344 patients.
- Exercise ECG testing on 322 patients, with follow-up exercise 201Tl myocardial scintigraphy.
- Dipyridamole 201Tl myocardial scintigraphy and dipyridamole echocardiography for patients unable to exercise.
- 24-hour Holter monitoring in 65 patients.
Main Results:
- Cardiac abnormalities found in 28% of patients; embologenic lesions in 17%.
- Exercise ECG testing revealed abnormalities in 17% of adequate examinations.
- Myocardial scintigraphy confirmed ischemic heart disease in 58 cases.
- Dipyridamole scintigraphy showed perfusion defects in 60% of cases.
- Arrhythmias detected in 41% of Holter monitoring cases, with limited correlation to cerebral events.
Conclusions:
- Systematic non-invasive cardiologic screening is essential for patients with recent cerebral ischemia.
- Recommended screening includes exercise ECG testing, followed by 201Tl myocardial scintigraphy if results are abnormal or indeterminate.
Abstract:
The cardiologic evaluation of patients with cerebral ischaemia should be aimed at: (1) identifying potential cardiac sources for cerebral emboli, (2) detecting a coexisting ischaemic heart disease, even asymptomatic. The present data concerns a ten-year experience of a systematic cardiologic evaluation of patients admitted to the 1st Division of Neurosurgery, Bellaria Hospital, Bologna, Italy, for cerebral ischaemia. A two-dimensional echocardiography was carried out in 344 consecutive patients (mean age 53 years), cardiac abnormalities were observed in 92 (28%) out of the 328 cases with technically adequate examination, embologenic lesions in 57 (17%). In 18 cases the cardiac lesion was unknown before the cerebral event. An exercise ECG testing was carried out in 322 patients (mean age 56 years), resulting in abnormal in 69 out of the 258 with adequate examination (17%). A subsequent exercise 201Tl myocardial scintigraphy confirmed the presence of ischaemic heart disease in 58 cases. Among patients unable to perform an adequate exercise, a dipyridamole 201Tl myocardial scintigraphy was performed in 38 cases showing perfusional defects in 23 (60%), while a dipyridamole echocardiography was performed in 25 cases showing wall motion abnormalities in 9 (36%). A 24-h Holter monitoring was performed in 65 cases: arrhythmias were detected in 27 patients (41%), but a correlation with the cerebral event was suggested only in 3 cases with atrial fibrillation. According to our experience patients with recent ischaemia should be submitted to the following non-invasive cardiologic screening: (1) exercise ECG testing followed, if abnormal or indeterminant, by 201Tl myocardial scintigraphy in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
