Patterns of Infarction on MRI in Patients With Acute Ischemic Stroke and Cardio-Embolism: A Systematic Review and Meta-Analysis

Abstract

Background: Cardioembolic strokes are common however atrial fibrillation, the most common cause, is often asymptomatic and difficult to detect. There is evidence that infarct topography and volume on magnetic resonance imaging may be associated with specific stroke etiologies.Aim: A systematic review and meta-analysis were undertaken to summarize the available evidence on the association between stroke etiology, infarct topography, and volume.Methods: A systematic review was conducted using Medline (OVID), Embase (OVID), and PubMed databases. Hand searches of the gray literature and of reference lists in relevant articles were also performed. A quality assessment was undertaken, based on the STROBE checklist. For each study, the number of patients with and without a CE source of stroke and infarct topography was collected and outcomes presented as odds ratios (OR) with 95% CI and p-values.Results: Four thousand eight hundred and seventy-three patients with ischemic stroke were included, of whom 1,559 were determined to have a CE source. Bilateral infarcts (OR 3.41; 95% CI 2.20–5.29; p < 0.0001) and multiple territory infarcts (OR 1.57; 95% CI 1.12–2.21; p = 0.009) were more common in patients with a CE source of stroke, than patients without a CE source. Lacunar infarcts (OR 0.49; 95% CI 0.31–0.80; p = 0.004) were more likely to occur in patients without a CE source. No significant difference between the frequency of multiple infarcts (OR 0.96; 95% CI 0.57–1.61; p = 0.87) anterior circulation (OR 1.45; 95% CI 0.83–2.53; p = 0.19) or posterior circulation infarcts (OR 1.06; 95% CI 0.72–1.57; p = 0.75), between the two groups were identified. Three out of four studies examining volume, found a significant association between increased infarct volume and CE source of stroke. A sensitivity analysis with cryptogenic and undetermined stroke sources assumed to be cardioembolic, did not alter the associations observed.Conclusion: The findings of this systematic review and meta-analysis are broadly consistent with previous literature and provide more robust evidence on the association between infarct topography, volume and stroke etiology. Our findings may assist with refining cardiac investigations for patients with cryptogenic stroke, based on infarct topography.

Risk of New-Diagnosed Atrial Fibrillation After Transient Ischemic Attack

“…This is especially so when we take into account that delayed diagnosis is related to an increased risk of SR as correct preventive strategies are also delayed. As in previous studies, we observed that the risk of new diagnosis of AF was related to age (31)(32)(33)(34)(35), previous IHD (35) and DWI patterns (36). We also identified sex differences in the proportion of new-diagnosed AF.…”

Early and long-term risk of new-onset atrial fibrillation after transient ischemic attack

“…This is especially so when we take into account that delayed diagnosis is related to an increased risk of SR as correct preventive strategies are also delayed. As in previous studies, we observed that the risk of new diagnosis of AF was related to age 26-30 , previous IHD 30 and DWI patterns 31 . We also identified sex differences in the proportion of new-onset AF.…”

Outcome after acute ischemic stroke is linked to sex-specific lesion patterns

“…Conceivably, female-specific lesion effects could be due to a higher frequency of cardioembolic strokes and associated typical lesion patterns (e.g., more multifocal stroke lesions) 83 . In a second ancillary analysis, we therefore sought to disentangle stroke-subtype- and sex-specific effects, and concurrently performed stroke-subtype- and sex-aware analyses, featuring two hierarchical levels.…”