Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography

Ava Leigh Liberman, Rizwan E. Kalani, Jessie Aw-Zoretic, Matthew Sondag, Vistasp J. Daruwalla, Sumeet S. Mitter, Richard Bernstein, Jeremy D. Collins, Shyam Prabhakaran

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
JournalInternational Journal of Stroke
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Transesophageal Echocardiography
Stroke
Magnetic Resonance Imaging
Embolism
Patent Foramen Ovale
Cardiomyopathies
Mitral Valve
Hospitalization
Cohort Studies
Research Personnel
Prospective Studies

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 journalArticle

Liberman, Ava Leigh ; Kalani, Rizwan E. ; Aw-Zoretic, Jessie ; Sondag, Matthew ; Daruwalla, Vistasp J. ; Mitter, Sumeet S. ; Bernstein, Richard ; Collins, Jeremy D. ; Prabhakaran, Shyam. / Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography. In: International Journal of Stroke. 2017.
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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.",
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AU - Sondag, Matthew

AU - Daruwalla, Vistasp J.

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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.

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