1. Hyperacute Incidental Late Myocardial Enhancement in Ischemic Stroke using Chest Spectral CT: Relationship with Etiology
- Author
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Diluca P, M.L. Caballero, Rodriguez-Granillo Ga, J.J. Cirio, Buezas, Pedro Lylyk, Fontana La, and C. Ciardi
- Subjects
medicine.medical_specialty ,Text mining ,business.industry ,Internal medicine ,Ischemic stroke ,medicine ,Etiology ,Cardiology ,business - Abstract
PurposeHyperacute cardiac imaging of patients with acute ischemic stroke (AIS), though desirable, is impractical. Using delayed-enhancement, low-dose, non-gated, chest spectral computed tomography scans (DESCT), we explored the prevalence and patterns of incidental myocardial late iodine enhancement (LIE) and embolic sources, and the relationship with stroke etiology. MethodsSince July 2020, DESCT was performed after cerebrovascular CT angiography (CTA) among patients with suspected AIS undergoing CT using a dual-layer spectral scanner, without additional contrast administration. Images were analyzed using monoenergetic reconstructions and iodine density maps, and the myocardial extracellular volume fraction (ECV, %) was calculated. ResultsEighty consecutive patients with AIS were included. DESCT identified a cardiac thrombi in 6 patients (7.5%), and a complex aortic plaque in 4 (5%) cases; reclassifying 5 embolic strokes of uncertain source (28% of ESUS) to cardioembolic (CE, n=3) and non-CE (n=2) etiologies. LIE, most commonly ischemic (82%), was identified in 38 (48%) patients. We did not identify significant relationships between AIS etiology and the presence, pattern, and extension of LIE (p>0.05); ECV (p=0.56), severe aortic (p=0.25) or valvular (p=0.26) disease, or the extent of coronary calcification (p=0.39). Patients with evidence of major cardiovascular DESCT findings had higher rate rates of all-cause death at 90 days (42% vs. 19%, p=0.037). ConclusionIn this study, hyperacute cardiac imaging of AIS with DESCT identified a high prevalence of incidental cardiac disease predominantly involving LIE of ischemic etiology and mostly not related to the stroke etiology.
- Published
- 2021