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Published on: August 28, 2018
Diagnostic yield of cardiac computed tomography in detecting high-risk cardioaortic embolic sources: A retrospective
Khansa Abdelazim Ahmed Osman1,2, Sherief Ghozy3,4, Michael Liu1
1Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Insights
Cardiac computed tomography angiography (CCTA) effectively identifies cardioaortic sources of embolism in ischemic stroke patients. This non-invasive imaging method shows clinical utility for detecting thrombi and plaques, aiding in stroke cause determination.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Ischemic stroke is a major global health concern, with cardioembolic sources being a significant cause.
- Accurate identification of structural heart abnormalities is crucial for managing ischemic stroke.
- Traditional imaging methods like TTE and TEE have limitations in detecting cardioaortic sources.
Purpose of the Study:
- To evaluate the diagnostic yield of CCTA compared to TTE and TEE.
- To assess CCTA's effectiveness in detecting high-risk cardioaortic sources of embolism in ischemic stroke patients.
- To compare CCTA's ability to identify left ventricular thrombus, left atrial thrombus, valvular thrombus, and ulcerated aortic plaques against TTE and TEE.
Main Methods:
- Retrospective, single-center cohort study at Mayo Clinic.
- Inclusion of 426 ischemic stroke patients who underwent CCTA within 30 days of stroke onset.
- Comparative analysis of diagnostic yields of CCTA, TTE, and TEE.
Main Results:
- CCTA demonstrated an overall diagnostic yield of 15.5% for high-risk cardioaortic sources.
- CCTA identified LV thrombus (2.3%), LA thrombus (4.0%), valvular thrombus (2.8%), and ulcerated aortic plaques (7.0%).
- CCTA showed a significantly higher yield than TTE (16.0% vs. 3.5%, P<0.001) and a comparable yield to TEE (25.3% vs. 20.7%, P=0.47).
Conclusions:
- CCTA is a viable non-invasive option for identifying high-risk cardioembolic sources in ischemic stroke.
- The ability to image soon after stroke onset enhances CCTA's clinical utility.
- Further prospective, blinded studies are needed to validate CCTA's efficacy in this patient population.
Background:
Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Cardioembolic sources account for a significant proportion of these events, necessitating accurate identification of underlying structural heart abnormalities. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCTA) has emerged as a potential alternative, offering non-invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi.
Objective:
This study aimed to evaluate the diagnostic yield of CCTA compared to TTE and TEE in detecting high-risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular thrombus, and ulcerated aortic plaques, in patients with ischemic stroke.
Methods:
We conducted a retrospective, single-center cohort study at Mayo Clinic, Rochester, MN, including 426 ischemic stroke patients who underwent CCTA within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCTA, TTE, and TEE in detecting structural cardiac sources of embolism.
Results:
The overall diagnostic yield of CCTA for detecting high-risk cardioaortic sources was 15.5%. Specifically, CCTA identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCTA demonstrated a higher yield than TTE (16.0% vs 3.5%, p < 0.001) and a comparable yield to TEE (25.3% vs 20.7%, p = 0.47) in detecting these sources.
Conclusions:
CCTA proved to be a viable option for identifying high-risk structural sources of cardioembolism in ischemic stroke patients. Its non-invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCTA in this context.
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