Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Karl Georg Haeusler; Christian Wollboldt; Laura Zu Bentheim; Juliane Herm; Sebastian Jäger; Claudia Kunze; Holger-Carsten Eberle; Claudia Christina Deluigi; Oliver Bruder; Carolin Malsch; Peter U Heuschmann; Matthias Endres; Heinrich J Audebert; Andreas J Morguet; Christoph Jensen; Jochen B Fiebach

doi:10.1161/STROKEAHA.116.016227

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Stroke. 2017 May;48(5):1241-1247. doi: 10.1161/STROKEAHA.116.016227. Epub 2017 Apr 14.

Authors

Karl Georg Haeusler¹, Christian Wollboldt², Laura Zu Bentheim², Juliane Herm², Sebastian Jäger², Claudia Kunze², Holger-Carsten Eberle², Claudia Christina Deluigi², Oliver Bruder², Carolin Malsch², Peter U Heuschmann², Matthias Endres², Heinrich J Audebert², Andreas J Morguet², Christoph Jensen², Jochen B Fiebach²

Affiliations

¹ From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany (C.M., P.U.H.); Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany (A.J.M.); German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany (M.E.); and German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Germany (M.E.); and Berlin Institute of Health, Germany (M.E.). georg.haeusler@charite.de.
² From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany (C.M., P.U.H.); Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany (A.J.M.); German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany (M.E.); and German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Germany (M.E.); and Berlin Institute of Health, Germany (M.E.).

PMID: 28411261
DOI: 10.1161/STROKEAHA.116.016227

Abstract

Background and purpose: Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up.

Methods: One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke.

Results: Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53-72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1-4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of κ=0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease.

Conclusions: Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01917955.

Keywords: echocardiography; embolism; magnetic resonance angiography; magnetic resonance imaging; stroke.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aorta, Thoracic / diagnostic imaging*
Brain Ischemia / diagnostic imaging
Brain Ischemia / etiology*
Cardiovascular Diseases / complications*
Cardiovascular Diseases / diagnostic imaging*
Echocardiography, Transesophageal / standards
Feasibility Studies
Female
Humans
Magnetic Resonance Angiography / standards
Magnetic Resonance Imaging / standards*
Male
Middle Aged
Reproducibility of Results
Stroke / diagnostic imaging
Stroke / etiology*

Associated data

ClinicalTrials.gov/NCT01917955