Multimodality Cardiac Imaging in Ischemic Stroke: Insights into the Heart-Brain Interaction.

Area of Science:

• Cardiology
• Neurology
• Radiology

Background:

• Ischemic stroke affects millions annually, with 25% originating from cardiac sources, posing high risks of recurrence and disability.
• Early detection and treatment of cardioembolic sources are crucial for stroke prevention, particularly in younger populations.

Purpose of the Study:

• To review the role of multimodality cardiac imaging in assessing cardioembolic stroke sources.
• To highlight emerging cardiac and systemic disorders linked to stroke and their diagnostic imaging capabilities.
• To discuss the brain-heart axis, including cardiac dysfunction following cerebrovascular events.

Main Methods:

• Comprehensive review of current cardiac imaging techniques beyond echocardiography.
• Inclusion of advanced modalities like cardiac MRI and CT.
• Discussion of adjunctive tests such as transcranial ultrasound with bubble studies for shunt detection.

Main Results:

• Cardiac imaging advancements significantly improve the detection of stroke-related cardiac disorders.
• Patent Foramen Ovale (PFO) is recognized as a distinct cardioembolic source, often acting as a mediator for venous embolisms.
• The study covers both heart-to-brain (cardioembolic sources) and brain-to-heart (neurogenic cardiac dysfunction) axes.

Conclusions:

• Post-stroke cardiac imaging now encompasses multiple modalities, requiring clinician familiarity with their diagnostic potential.
• Accurate diagnosis through advanced imaging is key to effective stroke treatment and recurrence prevention.
• Understanding the interplay between cardiac and neurological conditions is essential for comprehensive patient care.