High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging.

Autor: Kotadia ID; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom.; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., O'Dowling R; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Aboagye A; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Crawley RJ; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Bodagh N; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Gharaviri A; Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom., O'Hare D; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Solis-Lemus JA; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Roney CH; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Sim I; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Ramsey D; Princess Royal University Hospital London United Kingdom., Newby D; Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom., Chiribiri A; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Plein S; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Sztriha L; King's College Hospital London United Kingdom., Scott P; King's College Hospital London United Kingdom., Masci PG; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., Harrison J; Princess Royal University Hospital London United Kingdom., Williams MC; Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom., Birns J; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Somerville P; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Bhalla A; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Niederer S; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom., O'Neill M; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom.; Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom., Williams SE; School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom.; Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Feb 06; Vol. 13 (3), pp. e031489. Date of Electronic Publication: 2024 Jan 19.
DOI: 10.1161/JAHA.123.031489
Abstrakt: Background: Embolic stroke of unknown source (ESUS) accounts for 1 in 6 ischemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS, and beyond the identification of cardioembolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and noncardiac findings and to determine their impact on clinical care in patients with ESUS.
Methods and Results: In this prospective, multicenter, observational study, CMR imaging was performed within 3 months of ESUS. All scans were reported according to standard clinical practice. A new clinical finding was defined as one not previously identified through prior clinical evaluation. A clinically significant finding was defined as one resulting in further investigation, follow-up, or treatment. A change in patient care was defined as initiation of medical, interventional, surgical, or palliative care. From 102 patients recruited, 96 underwent CMR imaging. One or more new clinical findings were observed in 59 patients (61%). New findings were clinically significant in 48 (81%) of these patients. Of 40 patients with a new clinically significant cardiac finding, 21 (53%) experienced a change in care (medical therapy, n=15; interventional/surgical procedure, n=6). In 12 patients with a new clinically significant extracardiac finding, 6 (50%) experienced a change in care (medical therapy, n=4; palliative care, n=2).
Conclusions: CMR imaging identifies new clinically significant cardiac and noncardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04555538.
Databáze: MEDLINE
Externí odkaz: