Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence
| Autor: | Marly van Assen, Marco Scarabello, Akos Varga-Szemes, Carlo N. De Cecco, Sheldon E. Litwin, Georg Apfaltrer, Luca Saba, John W. Nance, Marwen Eid, Francesco Lavra, U. Joseph Schoepf, Domenico Mastrodicasa, L. Parkwood Griffith |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Doppler echocardiography ANGIOGRAPHY 030218 nuclear medicine & medical imaging 0302 clinical medicine Recurrence MAGNETIC-RESONANCE NORTH-AMERICAN-SOCIETY medicine.diagnostic_test Heart General Medicine Middle Aged Predictive value Magnetic Resonance Imaging ISCHEMIC-STROKE Echocardiography 030220 oncology & carcinogenesis brain embolism recurrence Cardiology cardiovascular system Female MRI medicine.medical_specialty Stroke recurrence ATRIAL APPENDAGE THROMBUS HEART-ASSOCIATION Sensitivity and Specificity TRANSESOPHAGEAL ECHOCARDIOGRAPHY 03 medical and health sciences Recurrent stroke Predictive Value of Tests Internal medicine medicine Humans Radiology Nuclear Medicine and imaging In patient cardiovascular diseases Thrombus Retrospective Studies NUCLEAR-CARDIOLOGY Cardioembolic stroke Embolic Stroke CTA business.industry Left ventricular thrombus medicine.disease body regions CARDIOVASCULAR-COMPUTED-TOMOGRAPHY business Tomography X-Ray Computed TASK-FORCE |
| Zdroj: | American Journal of Roentgenology, 217(2), 336-346. AMER ROENTGEN RAY SOC |
| ISSN: | 0361-803X |
| Popis: | BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques.OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke.METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI (n = 75) or CCTA (n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC.RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different (p>.05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients.CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus.CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings. |
| Databáze: | OpenAIRE |
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