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Predictors of Recurrent Stroke in Patients with Ischemic Stroke: Comparison Study between Transesophageal
Kyeho Lee1, Jin Hur1, Sae Rom Hong1
1From the Department of Radiology, Research Institute of Radiological Science (K.L., J.H., S.R.H., Y.J.S., D.J.I., Yun Jung Kim, Y.J.H., H.J.L., Young Jin Kim, B.W.C.), and Department of Biostatistics (H.S.L.), Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Republic of Korea; and Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea (G.R.H.).
Insights
Complex aortic plaque identified by cardiac computed tomography (CT) and transesophageal echocardiography (TEE) predicts recurrent stroke in patients with ischemic stroke. Both imaging methods show similar predictive capabilities for stroke recurrence.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Ischemic stroke poses a significant health burden, with recurrent events increasing morbidity and mortality.
- Identifying cardioembolic sources is crucial for stroke prevention strategies.
- Cardiac imaging modalities like CT and TEE play a role in evaluating potential stroke causes.
Purpose of the Study:
- To identify cardiac computed tomography (CT) findings predictive of recurrent stroke after an initial ischemic event.
- To compare the incremental risk stratification benefit of cardiac CT versus transesophageal echocardiography (TEE) for predicting stroke recurrence.
Main Methods:
- Prospective enrollment of 374 ischemic stroke patients who underwent both TEE and cardiac CT.
- Assessment of TEE and cardiac CT images for cardioembolic sources, including aortic plaque complexity.
- Follow-up for recurrent stroke events and analysis using Cox regression and time-dependent ROC curves.
Main Results:
- Complex aortic plaque, assessed by both TEE and cardiac CT, was a significant predictor of recurrent stroke.
- Cardiac CT (HR, 32.538) and TEE (HR, 13.512) both demonstrated significant association with stroke recurrence.
- No significant difference was observed in the predictive ability between CT and TEE parameters (AUCs 0.840 vs 0.812).
Conclusions:
- Complex aortic plaque is an independent risk factor for recurrent ischemic stroke.
- Cardiac CT and TEE offer comparable prognostic value in stratifying stroke recurrence risk.
- These findings support the use of cardiac CT and TEE in evaluating patients with ischemic stroke for risk stratification.
Purpose:
To investigate cardiac computed tomographic (CT) findings predictive of recurrent stroke in patients with ischemic stroke and determine the incremental risk stratification benefit of cardiac CT findings compared with transesophageal echocardiography (TEE) findings in patients with ischemic stroke.
Materials And Methods:
This single-center prospective study protocol was approved by the institutional review boards, and written informed consent was obtained from all patients. Among 548 consecutive patients, 374 patients with ischemic stroke (254 men and 120 women, with a mean age of 63.1 years) who underwent TEE and cardiac CT were prospectively enrolled in this study. TEE and cardiac CT images were assessed for cardioembolic sources, including thrombus, tumor, spontaneous echo contrast, valvular vegetation, atrial septal aneurysm, patent foramen ovale, and aortic plaque. The primary end point was stroke recurrence. Prognostic factors were assessed with Cox univariate and multivariate analysis. The integrated area under the receiver operating characteristic curve was calculated to compare the prognostic abilities of CT and TEE parameters.
Results:
During a median follow-up period of 433 days, there were a total of 28 recurrent stroke events. The TEE parameter of plaque complexity (hazard ratio, 13.512; 95% confidence interval: 3.668, 49.778; P < .001) and CT parameter of plaque complexity (hazard ratio, 32.538; 95% confidence interval: 7.544, 140.347; P < .001) were predictors of recurrent stroke. The time-dependent receiver operating characteristic curve analysis demonstrated no significant differences in prediction of recurrent stroke between TEE and CT parameters (integrated area under the receiver operating characteristic curve, 0.812 vs 0.840, respectively).
Conclusion:
Complex aortic plaque evaluated with cardiac CT and TEE was associated with an increased risk of stroke recurrence in patients with ischemic stroke.
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