Atrial CARdiac Magnetic resonance imaging in patients with embolic stroke of unknown source without documented Atrial Fibrillation (CARM-AF): Study design and clinical protocol

Kotadia, Irum; O’Dowling, Robert; Aboagye, Akosua; Sim, Iain; O’Hare, Daniel; Lemus-Solis, José-Alonso; Roney, Caroline H.; Dweck, Marc R; Chiribiri, Amedeo; Plein, Sven; Sztriha, L.; Scott, Paul A.; Harrison, James; Ramsay, Deborah; Birns, Jonathan; Somerville, Peter J.; Bhalla, Ajay; Niederer, Steven; O’Neill, Mark; Williams, Steven E.

doi:10.1016/j.hroo.2022.01.005

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…47 A recently published protocol for a prospective multicenter CARM-AF study will aim to identify patients with ESUS at risk of future thromboembolism due to atrial cardiomyopathy through non-invasive CMR and ECG data. 48 The unparalleled soft-tissue contrast and robust temporal resolution of CMR allow reliable detection and characterization of a variety of LV embolic sources (Figure 4(b) to (d)). CMR can accurately detect LV thrombi, which appear markedly hypointense on early and delayed enhancement images, 49 and reliably differentiate them from tumors and other cardiac masses (Figure 4(d)).…”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review

Khenkina

Aimo

Fabiani

et al. 2023

International Journal of Stroke

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Background Embolic stroke of undetermined source, or ESUS, refers to ischemic stroke where the underlying cause of thromboembolism cannot be found despite the recommended diagnostic workup. Unidentified source of emboli hinders clinical decision-making and patient’s management with detrimental consequences on long-term prognosis. Rapid development and versatility of MRI make it an appealing addition to the diagnostic routine of patients with ESUS for the assessment of potential vascular and cardiac embolic sources. Aims to review the use of MRI in the identification of cardiac and vascular embolic sources in ESUS and to assess the reclassification value of MRI examinations added to the conventional workup of ESUS Summary of review we reviewed the use of cardiac and vascular MRI for the identification of a variety of embolic sources associated with ESUS, including atrial cardiomyopathy, left ventricular pathologies, and supracervical atherosclerosis in carotid and intracranial arteries and in distal thoracic aorta. The additional reclassification after MRI examinations added to the workup of patients with ESUS ranged from 6.1 up to 82.3% and varied depending on the combination of imaging modalities. Conclusion MRI techniques allow to identify additional cardiac and vascular embolic sources and may further decrease the prevalence of patients with the diagnosis of ESUS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review

Khenkina

Aimo

Fabiani

et al. 2023

International Journal of Stroke

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“…The full study design has been previously published. 12 Ethical approval was granted by Health Research Authorities and the South London Research Ethics Committee (REC: 19//LO/1933). The study conforms to the principles outlined in the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

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

Kotadia,

O'Dowling,

Aboagye

et al. 2024

JAHA

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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.

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Ischemic stroke and the emerging role of left atrial function

Larsen,

Biering-Sørensen,

Olsen

2024

Expert Review of Cardiovascular Therapy

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Atrial CARdiac Magnetic resonance imaging in patients with embolic stroke of unknown source without documented Atrial Fibrillation (CARM-AF): Study design and clinical protocol

Cited by 4 publications

References 37 publications

Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review

Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review

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

Ischemic stroke and the emerging role of left atrial function

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