Cardiac imaging after ischemic stroke : Echocardiography, CT, or MRI?

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S Camen1,2, K G Haeusler3, R B Schnabel4,5

  • 1Department of General and Interventional Cardiology, Building O70, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.

Herz
|April 4, 2019
PubMed

Insights

Cardioembolic stroke, often linked to atrial fibrillation, requires cardiac imaging for effective secondary stroke prevention. Echocardiography is the primary diagnostic tool, though its impact on patient outcomes needs further research.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Approximately 20-25% of ischemic strokes are cardioembolic.
  • Atrial fibrillation and heart failure are the most frequent causes.
  • Noninvasive cardiac imaging is crucial for guiding stroke prevention therapy.

Purpose of the Study:

  • To evaluate the role of noninvasive cardiac imaging in diagnosing cardioembolic stroke.
  • To determine the effectiveness of echocardiography and other imaging modalities in managing stroke patients.

Main Methods:

  • Review of diagnostic work-up for ischemic stroke.
  • Focus on echocardiography (transthoracic and transesophageal) as a primary tool.
  • Assessment of cardiac computed tomography and magnetic resonance imaging as complementary methods.

Main Results:

  • Echocardiography, particularly transesophageal echocardiography, is highly sensitive for detecting cardioembolic sources.
  • Transesophageal echocardiography is recommended for initial diagnosis when a cardioembolic source is suspected.
  • Currently, no proven benefit of transesophageal echocardiography-guided therapy changes on major stroke outcomes exists.
  • Cardiac CT and MRI offer complementary information but are not recommended as first-line investigations.

Conclusions:

  • Echocardiography remains the cornerstone for cardiac imaging post-stroke.
  • Transesophageal echocardiography should be considered early for suspected cardioembolic sources.
  • Cardiac CT and MRI serve as valuable adjuncts in specific clinical scenarios.

Keywords:
Brain ischemiaComputed tomography, X‑rayEchocardiography, transesophagealEmbolismMagnetic resonance imaging

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