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Hyperacute Incidental Late Myocardial Enhancement in Ischemic Stroke Using Chest Spectral CT: Relationship with
Gaston A Rodriguez-Granillo1, Juan J Cirio2, Celina Ciardi2
1Department of Cardiovascular Imaging, Instituto Medico ENERI, Clinica La Sagrada Familia, C1428ARJ Buenos Aires, Argentina.
Insights
Delayed-enhancement spectral computed tomography (DESCT) scans can detect incidental cardiac disease in acute ischemic stroke (AIS) patients. While common, this myocardial late iodine enhancement (LIE) is often not directly related to stroke etiology.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Hyperacute cardiac imaging for acute ischemic stroke (AIS) is challenging.
- Delayed-enhancement spectral computed tomography (DESCT) offers a potential solution for incidental cardiac findings.
- This study investigates myocardial late iodine enhancement (LIE) and embolic sources in AIS patients.
Purpose of the Study:
- To explore the prevalence and patterns of incidental myocardial LIE in AIS patients.
- To identify embolic sources and their relationship with stroke etiology.
- To assess the utility of DESCT in cardiac assessment of AIS.
Main Methods:
- DESCT was performed post-cerebrovascular CT angiography in suspected AIS patients.
- Images were analyzed using monoenergetic reconstructions and iodine density maps.
- Myocardial extracellular volume fraction (ECV) was calculated.
Main Results:
- DESCT identified cardiac thrombi in 7.5% and complex aortic plaque in 5% of patients.
- LIE was found in 48% of patients, predominantly ischemic.
- No significant relationship was found between LIE and stroke etiology, ECV, or valvular/aortic disease.
Conclusions:
- DESCT reveals a high prevalence of incidental cardiac disease in AIS patients.
- Myocardial LIE is common but often not directly linked to stroke cause.
- Major DESCT findings correlated with increased 90-day all-cause mortality.
Background:
Hyperacute cardiac imaging of patients with acute ischemic stroke (AIS), though desirable, is impractical. Using delayed-enhancement, low-dose, non-gated, chest spectral computed tomography scans (DESCT), we explored the prevalence and patterns of incidental myocardial late iodine enhancement (LIE) and embolic sources, and their relationship with stroke etiology.
Methods:
Since July 2020, DESCT was performed after cerebrovascular CT angiography (CTA) among patients with suspected AIS undergoing CT using a dual-layer spectral scanner, without additional contrast administration. Images were analyzed using monoenergetic reconstructions and iodine density maps, and the myocardial extracellular volume fraction (ECV, %) was calculated.
Results:
Eighty patients with AIS were included. DESCT identified a cardiac thrombi in 6 patients (7.5%), and a complex aortic plaque in 4 (5%) cases; reclassifying 5 embolic strokes of uncertain source (28% of ESUS) to cardioembolic (CE, n = 3) and non-CE (n = 2) etiologies. LIE was identified in 38 (48%) patients, most commonly (82%) of ischemic pattern. We did not identify significant relationships between AIS etiology and the presence, pattern, and extent of LIE (p > 0.05); ECV (p = 0.56), severe aortic (p = 0.25) or valvular (p = 0.26) disease, or the extent of coronary calcification (p = 0.39). Patients with evidence of major cardiovascular DESCT findings had higher rates of all-cause death at 90 days (42% vs. 19%, p = 0.037).
Conclusions:
In this study, hyperacute cardiac imaging of AIS with DESCT identified a high prevalence of incidental cardiac disease predominantly involving LIE of ischemic etiology and mostly not related to the stroke etiology.
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