The potential role for ultrafast cardiac computed tomography in patients with stroke.

Helgason, Cathy M.; Chomka, Eva V.; Louie, Eric K.; Rich, Stuart; Zając, Ewelina; Roig, Eulàlia; Wilbur, Andrew C.; Brundage, Bruce H.

doi:10.1161/01.str.20.4.465

Cited by 18 publications

(9 citation statements)

References 41 publications

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“…Using 2DE and UFFCT, Helgason et al 18 evaluated patients with suspected cardioembolic stroke and found a slightly higher incidence of technically difficult 2DE studies (43%) than we did (32%). Either 2DE or UFCCT detected intracardiac thrombi in 13 of the 40 patients in that series.…”

contrasting

confidence: 58%

Comparison of two-dimensional echocardiography and ultrafast cardiac computed tomography for evaluating intracardiac thrombi in cerebral ischemia.

Love

Struck

Stanford

et al. 1990

Stroke

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Two-dimensional echocardiography has a high specificity for the detection of intracardiac thrombi, but technically difficult studies are often encountered. Ultrafast cardiac computed tomography may be useful in such cases. Using transthoracic two-dimensional echocardiography and ultrafast cardiac computed tomography, we studied 36 patients with cerebral ischemia; one patient had the studies performed on two occasions, making a total of 37 sets of studies. Technical difficulties occurred in 12 echocardiographic (32%) and two ultrafast cardiac computed tomographic (5%) studies. The two techniques agreed in 29 sets of studies (78%). Among the eight discrepant sets of studies, two-dimensional echocardiography was positive for a left ventricular thrombus while ultrafast cardiac computed tomography was negative in three and equivocal in one and echocardiography was equivocal while ultrafast cardiac computed tomography was negative in two and positive in one. In the latter case, a left ventricular thrombus was confirmed at autopsy. In the other discrepant set of studies echocardiography was negative while ultrafast cardiac computed tomography revealed a left atrial and appendage thrombus. Because of its ease of performance and safety, two-dimensional echocardiography is the appropriate initial screening test for left ventricular thrombus. Ultrafast cardiac computed tomography can provide additional information in patients with technically difficult or equivocal two-dimensional echocardiographic studies or patients with cardiac disorders predisposing to atrial thrombi formation. (Stroke 1990;21:1033-1038)

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contrasting

confidence: 58%

Comparison of two-dimensional echocardiography and ultrafast cardiac computed tomography for evaluating intracardiac thrombi in cerebral ischemia.

Love

Struck

Stanford

et al. 1990

Stroke

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“…Cardiac ultrafast CT has higher specificity for the detection of ventricular thrombi than two-dimensional echocardiography. 62 However, the need for contrast material is a disadvantage, and one cannot perform serial bedside examinations. Finally, the ultrafast CT systems are not widely available at this time.…”

Section: Left Ventricular Thrombimentioning

confidence: 99%

Cardiac evaluation of the patient with stroke.

Sirna

Biller

Skorton

et al. 1990

Stroke

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Coronary artery disease and ischemic cerebrovascular disease are leading causes of morbidity and mortality in the United States. Coronary artery disease often coexists with asymptomatic carotid artery atherosclerosis, transient ischemic attacks, or ischemic stroke. Numerous studies have shown that mortality from all forms of ischemic cerebrovascular disease is primarily due to coronary artery disease. Thus, there is increasing interest in identifying coronary artery disease in patients with cerebrovascular disease, including those without clinical manifestations of heart disease. We review the use of current noninvasive techniques to detect coronary artery disease and present practical approaches to screen for ischemic heart disease. Current diagnostic imaging methods for potential cardioembolic sources of cerebral infarction are also discussed.

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“…Only 2 out of 14 (14.3%) studies had a low risk of bias for all of the domains of the QUADAS-2 checklist [16,18]. Concerns regarding applicability were generally low except for the domain 'interpretation and conduct of the index-test' for which two studies scored a high concern due to using outdated CT scanners (Imatron C-100) [15,16].…”

Section: Study Qualitymentioning

confidence: 99%

“…We identified 1530 publications in the initial search, of which 42 were selected for full-length review. Of these, 14 articles fulfilled the inclusion criteria and were included in the analyses [8,[15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Study Selectionmentioning

confidence: 99%

CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis

et al. 2020

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Background and purpose Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. Methods We performed a systematic review and meta-analysis of the literature on cardiac CTA versus echocardiography for detection of cardiac thrombi in ischemic stroke patients. We included studies (N ≥ 20) in which both cardiac CTA (index test) and echocardiography (reference test) were performed and data on cardiac thrombi were reported. Results were stratified for type of echocardiography: transesophageal (TEE) vs transthoracic (TTE). Results Out of 1530 studies, 14 were included (all single center cohort studies), with data on 1568 patients. Mean age varied between 52 and 69 years per study and 66% were men. Reported time intervals ranged from 0 to 21 days between stroke and first test, and from 0 to 199 days between tests. In ten studies that compared CTA to TEE, CTA detected cardiac thrombi in 87/1385 (6.3%) patients versus 68/1385 (4.9%) on TEE (p < 0.001). In four studies comparing CTA to TTE, CTA detected thrombi in 23/183 (12.5%) patients versus 12/183 (6.6%) on TTE (p = 0.010). Pooled sensitivity and specificity of CTA versus TEE were 86.0% (95% CI 65.6-95.2) and 97.4% (95% CI 95.0-98.7), respectively. Conclusions CTA may be a promising alternative to echocardiography for detection of cardiac thrombi in patients with ischemic stroke, especially now that CTA is standard care for patient selection for endovascular treatment. However, studies were too heterogeneous and of insufficient methodological quality to draw firm conclusions. Large, prospective studies on this topic are warranted.

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The potential role for ultrafast cardiac computed tomography in patients with stroke.

Cited by 18 publications

References 41 publications

Comparison of two-dimensional echocardiography and ultrafast cardiac computed tomography for evaluating intracardiac thrombi in cerebral ischemia.

Comparison of two-dimensional echocardiography and ultrafast cardiac computed tomography for evaluating intracardiac thrombi in cerebral ischemia.

Cardiac evaluation of the patient with stroke.

CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis

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