Cardiac imaging after ischemic stroke

Abstract

About 20–25% of all ischemic strokes are of cardioembolic etiology, with atrial fibrillation and heart failure as the most common underlying pathologies. Diagnostic work-up by noninvasive cardiac imaging is essential since it may lead to changes in therapy, e.g., in—but not exclusively—secondary stroke prevention. Echocardiography remains the cornerstone of cardiac imaging after ischemic stroke, with the combination of transthoracic and transesophageal echocardiography as gold standard thanks to their high sensitivity for many common pathologies. Transesophageal echocardiography should be considered as the initial diagnostic tool when a cardioembolic source of stroke is suspected. However, to date, there is no proven benefit of transesophageal echocardiography-related therapy changes on the main outcomes after ischemic stroke. Based on the currently available data, cardiac computed tomography and magnetic resonance imaging should be regarded as complementary methods to echocardiography, providing additional information in specific situations; however, they cannot be recommended as first-line modalities.

The Role of Echocardiography Screening at the Stroke Unit

“…Additionally, in cases of early recurrent embolism whether atrial thrombus is suspected. However, TTE has some difficulty evaluating the LA appendage where a thrombus may be lodged, although the development of real-time three-dimensional TTE can interrogate the LA appendage (12,13).…”

“…Although TEE is the ultrasound modality of choice for the detection of aortic arch atheromatosis, many patients do not tolerate the test or they do not meet the cardiologist's criteria for TEE. Aortic CT is a good alternative but it is not ideal to evaluate mobile thrombi (12). The aortic arch may be rapidly assessed in many patients with TTE from the suprasternal window (33).…”

Neues beim Schlaganfall unter besonderer Berücksichtigung älterer Patienten

“…Die kardiale Bildgebung mittels MRT oder CT sollte als Ergänzung der Echokardiografie betrachtet werden, die in bestimmten Konstellationen relevante Zusatzinformationen liefern kann [19]. Es sei in diesem Kontext explizit darauf verwiesen, dass ein relevanter Anteil der Schlaganfallpatienten aufgrund einer kardialen Erkrankung verstirbt.…”

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

“…Transthoracic (TTE) and/or transesophageal echocardiography (TEE) are the standard methods for cardiac imaging after ischemic stroke [5,6]. In recent years, reports on the use of cardiac magnetic resonance imaging (MRI) and computed tomography (CT) after stroke have been increasingly published, particularly in patients with unknown stroke etiology [7][8][9][10]. Cardiac work-up after stroke might lead to changes in secondary stroke prevention, guide screening for atrial fibrillation, and serve as a screening tool for (coronary) heart disease given the strong overlap of cerebrovascular and cardiovascular risk factors [11,12].…”

“…Advantages, disadvantages, and diagnostic value of cardiac imaging methods (modified according to[10])…”