Total Bolus Transit Time Predicts Cardiac Dysfunction in Acute Ischemic Stroke and Transient Ischemic Attack...

Area of Science:

• Radiology
• Cardiology
• Neurology

Background:

• Rapid diagnosis of cardioembolic stroke/TIA is challenging due to insufficient data from current cardiac assessments.
• Brain CT angiography (CTA) is routinely used in acute stroke evaluation.
• Bolus tracking is a readily available technique during CTA.

Purpose of the Study:

• To evaluate the utility of bolus tracking during brain CTA for identifying reduced ejection fraction (EF) and cardioembolic etiology in acute stroke patients.
• To determine if bolus tracking parameters correlate with EF and can predict cardioembolic stroke.

Main Methods:

• Retrospective analysis of CTA and echocardiography data from 443 acute ischemic stroke/TIA patients.
• Measurement of total transit time (TTT) parameters (T40HU, T100HU, ΔT100-T40HU) from CTA.
• Ejection fraction (EF) measurement using transthoracic echocardiography (Simpson biplane method).

Main Results:

• A significant inverse correlation was found between EF and T40HU, T100HU, and ΔT100-T40HU.
• ΔT100-T40HU showed good discriminatory ability for heart failure (AUROC=0.88).
• Multivariate analysis confirmed T40HU, T100HU, and ΔT100-T40HU as independent predictors of heart failure and cardioembolic stroke.

Conclusions:

• Bolus tracking during CTA is a reliable radiological tool for identifying heart failure and cardioembolic stroke.
• This technique facilitates faster diagnostic workup in acute stroke patients.
• It enables appropriate selection of further diagnostic investigations in emergency settings.