Cardiac stasis imaging, stroke, and silent brain infarcts in patients with nonischemic dilated cardiomyopathy

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Nonischemic dilated cardiomyopathy (NIDCM) significantly increases stroke risk.
• Anticoagulation for primary stroke prevention in NIDCM is limited by bleeding risks.
• Identifying patients at high risk for stroke is crucial for personalized treatment.

Purpose of the Study:

• To investigate if cardiac blood stasis indices derived from echocardiography can predict stroke risk in NIDCM patients.
• To assess the utility of stasis imaging for individualizing primary prevention strategies, particularly anticoagulation.

Main Methods:

• Cross-sectional study involving 89 NIDCM patients (left ventricular ejection fraction <45%) in sinus rhythm.
• Patients were recruited from prospective and retrospective cohorts, including those with prior cardioembolic events.
• Echocardiography was used to calculate intraventricular blood flow, residence time (T_R) maps, and derived stasis indices.

Main Results:

• 18 patients met the primary endpoint (history of stroke/TIA, intraventricular thrombus, or silent brain infarction).
• Averaged T_R demonstrated good performance in identifying the primary endpoint (AUC = 0.75, P = 0.001).
• T_R was highly accurate in identifying patients with a history of stroke or TIA (AUC = 0.92, P < 0.001), with an odds ratio of 7.2 per cycle.

Conclusions:

• Echocardiography-derived intraventricular stasis metrics correlate with stroke burden in NIDCM patients in sinus rhythm.
• Stasis imaging shows potential for identifying individuals who may benefit from primary prevention anticoagulation.
• These novel metrics could enable personalized stroke risk assessment and treatment in NIDCM.