Undetermined stroke genesis and hidden cardiomyopathies determined by cardiac magnetic resonance
Ana Catarina Fonseca1, João Pedro Marto2, Daniela Pimenta2
1From the Department of Neurology (A.C.F., D.P., P.N.A., T.P.e.M., J.M.F.), Hospital de Santa Maria, Institute of Molecular Medicine, University of Lisboa; Department of Neurology (J.P.M., M.V.-B.), Hospital Egas Moniz; Department of Cardiology (T.G., F.J.P., A.G.A.), Hospital de Santa Maria, University of Lisboa; and Department of Neurology (N.I.), Hospital Beatriz Ângelo, Lisbon, Portugal. acfonseca@medicina.ulisboa.pt.
Insights
Cardiac magnetic resonance imaging (CMR) identified previously undiagnosed cardiomyopathies in 5.3% of ischemic stroke patients. These findings suggest cardiomyopathies are a potential cause of stroke, especially when the etiology is undetermined.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Ischemic stroke often presents with an undetermined etiology after standard investigations.
- Cardiomyopathies are a group of heart muscle diseases that can lead to stroke.
- Cardiac magnetic resonance imaging (CMR) offers detailed visualization of cardiac structure and function.
Purpose of the Study:
- To evaluate the utility of CMR in detecting undiagnosed cardiomyopathies in ischemic stroke patients.
- To characterize the types and prevalence of cardiomyopathies identified by CMR in this cohort.
- To compare cardiomyopathy frequencies in stroke patients with general population data.
Main Methods:
- A subanalysis of a prospective cohort of ischemic stroke patients was performed.
- Patients with echocardiographically evident causal structural heart changes were excluded.
- A 3T CMR was conducted, and findings were compared to general population reference values.
Main Results:
- CMR identified cardiomyopathy in 5.3% of 132 ischemic stroke patients.
- Identified cardiomyopathies included hypertrophic (4), restrictive (2), and noncompaction (1).
- Higher frequencies of hypertrophic and noncompaction cardiomyopathies were observed compared to the general population.
Conclusions:
- Cardiomyopathies are a potential, albeit rare, cause of ischemic stroke, particularly in cases of undetermined etiology.
- CMR is a valuable tool for identifying these previously undiagnosed cardiac conditions.
- Consideration of cardiomyopathy is crucial in the etiological workup of ischemic stroke.
Objective:
To determine whether cardiac magnetic resonance imaging (CMR) could be useful in identifying previously undiagnosed cardiomyopathies in a cohort of patients with ischemic stroke who underwent standard etiologic investigation and to describe the type and frequency of these cardiomyopathies.
Methods:
We performed a subanalysis of a previously collected prospective cohort of patients with ischemic stroke. Patients with structural changes on echocardiography that are considered causal for stroke in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3T CMR was performed. We compared the frequency of the cardiomyopathies that we found with reference values for the general population.
Results:
One hundred thirty-two patients with a mean age of 68.4 years were included. In 7 patients (5.3%, 95% confidence interval 2.59%-10.54%) CMR identified cardiomyopathy. Four patients had hypertrophic cardiomyopathy, 2 had restrictive cardiomyopathy, and 1 had noncompaction cardiomyopathy. Six of these patients had been classified after standard evaluation as having undetermined stroke and 1 patient as having cardioembolic stroke (atrial fibrillation). We found a higher frequency of hypertrophic cardiomyopathy in the entire cohort and in the undetermined cause group compared to the general population (3.03% and 5.81% vs 0.2%, respectively, p = 0.001 and p < 0.001). The frequency of noncompaction cardiomyopathy was also higher in our cohort (0.76% vs 0.05%, respectively, p < 0.001).
Conclusions:
Although rare, cardiomyopathies should be considered as a possible cause of ischemic stroke classified as of undetermined etiology after standard evaluation.
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