Long‐Term Clinical Implications of High‐Risk Cardiac Computed Tomography Findings in Patients With Acute Ischemic Stroke

Author:

Rinkel Leon A.1ORCID,Cramer Olivia N.1,Özata Z. Beyda1,Beemsterboer Chiel F. P.1ORCID,Guglielmi Valeria1ORCID,Nio Shan Sui1,Bouma Berto J.2ORCID,Boekholdt S. Matthijs2ORCID,Lobé Nick H. J.3ORCID,Beenen Ludo F. M.3ORCID,Marquering Henk A.34ORCID,Majoie Charles B. L. M.3ORCID,Roos Yvo B. W. E. M.1ORCID,van Randen Adrienne3ORCID,Planken R. Nils3ORCID,Coutinho Jonathan M.1ORCID

Affiliation:

1. Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands

2. Department of Cardiology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands

3. Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands

4. Departments of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands

Abstract

Background Cardiac computed tomography (CT) acquired during the initial acute stroke imaging protocol (acute cardiac CT) is increasingly used to screen for cardioembolism, but information on the long‐term clinical implications of its findings is lacking. Methods and Results We performed a prospective, single‐center cohort study in which consecutive patients with ischemic stroke underwent ECG‐gated acute cardiac CT and were followed up for 2 years. The primary outcome was functional outcome assessed using the modified Rankin Scale. Secondary outcomes were death and occurrence of major adverse cardiovascular events (composite of recurrent ischemic stroke, myocardial infarction, and cardiovascular death). We compared patients with and without a high‐risk structural source of embolism on acute cardiac CT. Of 452 included patients, 55 (12.2%) had a high‐risk source of embolism, predominantly cardiac thrombi (38 patients) and signs of endocarditis (8 patients). Follow‐up at 2 years was complete for 430 (95.1%) patients. Patients with a high‐risk source of embolism had a worse functional outcome (median modified Rankin Scale, 6 [IQR, 2–6] versus 2 [IQR, 1–5]; adjusted common odds ratio, 2.92 [95% CI, 1.62–5.25]), increased mortality rate (52.7% versus 23.7%; adjusted hazard ratio [HR], 3.28 [95% CI, 1.94–5.52]), and major adverse cardiovascular events (38.9% versus 17.5%; adjusted HR, 3.20 [95% CI, 1.80–5.69]). A high‐risk source of embolism was not associated with recurrent ischemic stroke (11.1% versus 9.6%; adjusted HR, 1.30 [95% CI, 0.49–3.44]). Conclusions Structural high‐risk sources of embolism on acute cardiac CT in patients with ischemic stroke were associated with poor long‐term functional outcome and occurrence of major adverse cardiovascular events but not with recurrent stroke.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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