Evaluation of left ventricular function in patients with acute ischaemic stroke using cine cardiovascular magnetic resonance imaging

Abstract

Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real-time (CRT) sequences with the reference of segmented cine steady-state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT 02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56-111) and 54 h (interquartile range 31-78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78-1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.

Enhanced diagnostic workup increases pathological findings in patients with acute ischaemic stroke: results of the prospective HEBRAS study

“…10 11 With adequate assessment of the left atrium and the aortic arch being necessary to rule out high-risk sources of cardioembolism, 6 cardiovascular MR imaging (CMR) has been found feasible in selected patients with AIS and has become a complimentary diagnostic method to the clinical gold standard echocardiography. [12][13][14] With regard to the detection of arrhythmias, prolonged ECG monitoring has been found to increase the rate of patients diagnosed with atrial fibrillation (AF) after AIS. 5 15 However, there is no randomised controlled trial demonstrating a benefit of prolonged ECG monitoring in secondary stroke prevention.…”

Myocardial injury in acute ischemic stroke

“…Cardiovascular MRI (CMR) was proven feasible in stroke patients and allowed identification of systolic and diastolic dysfunction. 54 Including contrast agent-based sequences, CMR enables to detect late gadolinium enhancement (LGE). CMR allows excellent tissue characterization and may identify and differentiate vital myocardium, scaring (LGE), nonischemic diffuse fibrosis (via T1 mapping), and edema (T2 mapping)/extracellular volume fraction (%).…”