Abstract
Background: The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods: A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included. All cardiac magnetic resonance imaging studies underwent independent, blinded review by two investigators. We applied the causative classification system for ischemic stroke to all patients, first blinded to cardiac magnetic resonance imaging results; we then reapplied the causative classification system using cardiac magnetic resonance imaging. Standard statistical tests to evaluate stroke subtype reclassification rates were used. Results: Ninety-three patients were included in the final analysis; 68.8% were classified as cryptogenic stroke after initial diagnostic evaluation. Among patients with cryptogenic stroke, five (7.8%) were reclassified due to cardiac magnetic resonance imaging findings: one was reclassified as “cardio-aortic embolism evident” due to the presence of a patent foramen ovale and focal cardiac infarct and four were reclassified as “cardio-aortic embolism possible” due to mitral valve thickening (n = 1) or hypertensive cardiomyopathy (n = 3). Overall, findings on cardiac magnetic resonance imaging reduced the percentage of patients with cryptogenic stroke by slightly more than 1%. Conclusion: Our stroke subtype reclassification rate after the addition of cardiac magnetic resonance imaging results to a diagnostic work-up which includes transesophageal echocardiography was very low. Prospective studies evaluating the role of cardiac magnetic resonance imaging and transesophageal echocardiography among patients with cryptogenic stroke should be considered.
| Original language | English (US) |
|---|---|
| Journal | International Journal of Stroke |
| DOIs | |
| State | Accepted/In press - Jan 1 2017 |
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Keywords
- cardiac magnetic resonance imaging
- Cryptogenic stroke
- diagnostic testing
- ischemic stroke subtype
- transesophageal echocardiography
ASJC Scopus subject areas
- Neurology
Cite this
Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography. / Liberman, Ava Leigh; Kalani, Rizwan E.; Aw-Zoretic, Jessie; Sondag, Matthew; Daruwalla, Vistasp J.; Mitter, Sumeet S.; Bernstein, Richard; Collins, Jeremy D.; Prabhakaran, Shyam.
In: International Journal of Stroke, 01.01.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography
AU - Liberman, Ava Leigh
AU - Kalani, Rizwan E.
AU - Aw-Zoretic, Jessie
AU - Sondag, Matthew
AU - Daruwalla, Vistasp J.
AU - Mitter, Sumeet S.
AU - Bernstein, Richard
AU - Collins, Jeremy D.
AU - Prabhakaran, Shyam
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background: The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods: A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included. All cardiac magnetic resonance imaging studies underwent independent, blinded review by two investigators. We applied the causative classification system for ischemic stroke to all patients, first blinded to cardiac magnetic resonance imaging results; we then reapplied the causative classification system using cardiac magnetic resonance imaging. Standard statistical tests to evaluate stroke subtype reclassification rates were used. Results: Ninety-three patients were included in the final analysis; 68.8% were classified as cryptogenic stroke after initial diagnostic evaluation. Among patients with cryptogenic stroke, five (7.8%) were reclassified due to cardiac magnetic resonance imaging findings: one was reclassified as “cardio-aortic embolism evident” due to the presence of a patent foramen ovale and focal cardiac infarct and four were reclassified as “cardio-aortic embolism possible” due to mitral valve thickening (n = 1) or hypertensive cardiomyopathy (n = 3). Overall, findings on cardiac magnetic resonance imaging reduced the percentage of patients with cryptogenic stroke by slightly more than 1%. Conclusion: Our stroke subtype reclassification rate after the addition of cardiac magnetic resonance imaging results to a diagnostic work-up which includes transesophageal echocardiography was very low. Prospective studies evaluating the role of cardiac magnetic resonance imaging and transesophageal echocardiography among patients with cryptogenic stroke should be considered.
AB - Background: The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods: A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included. All cardiac magnetic resonance imaging studies underwent independent, blinded review by two investigators. We applied the causative classification system for ischemic stroke to all patients, first blinded to cardiac magnetic resonance imaging results; we then reapplied the causative classification system using cardiac magnetic resonance imaging. Standard statistical tests to evaluate stroke subtype reclassification rates were used. Results: Ninety-three patients were included in the final analysis; 68.8% were classified as cryptogenic stroke after initial diagnostic evaluation. Among patients with cryptogenic stroke, five (7.8%) were reclassified due to cardiac magnetic resonance imaging findings: one was reclassified as “cardio-aortic embolism evident” due to the presence of a patent foramen ovale and focal cardiac infarct and four were reclassified as “cardio-aortic embolism possible” due to mitral valve thickening (n = 1) or hypertensive cardiomyopathy (n = 3). Overall, findings on cardiac magnetic resonance imaging reduced the percentage of patients with cryptogenic stroke by slightly more than 1%. Conclusion: Our stroke subtype reclassification rate after the addition of cardiac magnetic resonance imaging results to a diagnostic work-up which includes transesophageal echocardiography was very low. Prospective studies evaluating the role of cardiac magnetic resonance imaging and transesophageal echocardiography among patients with cryptogenic stroke should be considered.
KW - cardiac magnetic resonance imaging
KW - Cryptogenic stroke
KW - diagnostic testing
KW - ischemic stroke subtype
KW - transesophageal echocardiography
UR - http://www.scopus.com/inward/record.url?scp=85032270851&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032270851&partnerID=8YFLogxK
U2 - 10.1177/1747493017706242
DO - 10.1177/1747493017706242
M3 - Article
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
ER -