High prevalence of new clinically significant findings in patients with embolic stroke of unknown source evaluated by cardiac magnetic resonance imaging

Irum D. Kotadia, Robert O'Dowling, Akosua Aboagye, Richard J. Crawley, Neil Bodagh, Daniel O'Hare, José-Alonso Lemus-Solis, Caroline H Roney, Iain Sim, Deborah Ramsay, David E Newby, Ali Gharaviri, Amedeo Chiribiri, Sven Plein, Laszlo Sztriha, Paul Scott, Pier Giorgio Masci, James Harrison, Michelle C Williams, Jonathan BirnsPeter Somerville, Ajay Bhalla, Steven Niederer, Mark O'Neill, Steven Williams

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Embolic stroke of unknown source (ESUS) accounts for one in six ischaemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS and, beyond the identification of cardio-embolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and non-cardiac findings and to determine their impact on clinical care in patients with ESUS.
Methods and Results: In this prospective, multicentre, observational study, CMR 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. 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 extra-cardiac 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 non-cardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS.
Original languageEnglish
JournalJournal of the American Heart Association
Publication statusPublished - 19 Jan 2024

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