Abstract TP417: Advanced Cardiac Imaging in Patients With Ischemic Stroke: When to Scan?

Abstract

Background: Advanced cardiac imaging(ACI) with cardiac CT (CCT) and cardiac MR (CMR) are valuable noninvasive investigative tools to assess cardiac structure in cryptogenic stroke assessment. In this study, we examine patient, electrocardiographic (EKG), and TTE variables associated with subsequent detection of intracardiac thrombus using CCT and CMR in patients with cryptogenic stroke. Methods: The Medical University of South Carolina Comprehensive stroke center database was used to identify acute ischemic stroke patients who received inpatient CCT or CMR between January 2017 to May 2018. Patient demographics, past medical history, EKG, and TTE related variables were abstracted by 2 physicians. Univariate and multivariable logistic regression was used to identify factors associated with detection of intracardiac thrombus on CCT/CMR. Negative and positive predictive value (NPV and PPV) were calculated for TTE, with CCT/CMR considered as gold standard. Results: 256 subjects received CCT/CMR after TTE during the study period; with 25 (9.7%) found to have an intracardiac thrombus [12 (4.7%) LV thrombus, 6 (2.3%) LA thrombus, 7 (2.8%) Others including myxoma,valve aortic arch thrombus]. The PPV and NPV of TTE were 57% and 93% respectively. Mild-Modertely Reduced (30-50% EF was associated with subsequent detection of intracardiac thrombus onCCT/CMR in univariate model, but did not reach significance after adjusting for other variables. Atrial fibrillation, P wave abnormality on EKG, ST changes on EKG, Left Ventricle wall motion akinesia on TTE were associated with intracardiac thrombus on CCT/CMR in both models. Conclusion: Advanced cardiac imaging is a useful noninvasive tool to identify cardiac source of ischemic stroke. Although small sample size and inadequate power may limit generalizability, patients with atrial fibrillation, P wave and ST changes on EKG, and LV wall motion akinesis should be considered for advanced cardiac.