Hyperacute Incidental Late Myocardial Enhancement in Ischemic Stroke Using Chest Spectral CT: Relationship with Etiology

Hyperacute cardiac imaging of patients with acute ischemic stroke (AIS), though desirable, is impractical. Using delayed-enhancement, low-dose, non-gated, chest spectral computed tomography scans (DESCT), we explored the prevalence and patterns of incidental myocardial late iodine enhancement (LIE)...

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Bibliographic Details
Published in:	Reviews in cardiovascular medicine Vol. 23; no. 3; p. 93
Main Authors:	Rodriguez-Granillo, Gaston A, Cirio, Juan J, Ciardi, Celina, Caballero, Maria L, Fontana, Lucia A, Buezas, Mariano D, Diluca, Pablo, Lylyk, Pedro
Format:	Journal Article
Language:	English
Published:	Singapore IMR Press 09-03-2022
Subjects:	cardiac disease cardiovascular computed tomography dual energy embolic stroke Humans Iodine Ischemic Stroke myocardial delayed-enhancement Myocardium Stroke - diagnostic imaging Stroke - epidemiology Tomography, X-Ray Computed - adverse effects Tomography, X-Ray Computed - methods cardiac disease myocardial delayed-enhancement embolic stroke cardiovascular computed tomography dual energy
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Summary:	Hyperacute cardiac imaging of patients with acute ischemic stroke (AIS), though desirable, is impractical. Using delayed-enhancement, low-dose, non-gated, chest spectral computed tomography scans (DESCT), we explored the prevalence and patterns of incidental myocardial late iodine enhancement (LIE) and embolic sources, and their relationship with stroke etiology. Since July 2020, DESCT was performed after cerebrovascular CT angiography (CTA) among patients with suspected AIS undergoing CT using a dual-layer spectral scanner, without additional contrast administration. Images were analyzed using monoenergetic reconstructions and iodine density maps, and the myocardial extracellular volume fraction (ECV, %) was calculated. Eighty patients with AIS were included. DESCT identified a cardiac thrombi in 6 patients (7.5%), and a complex aortic plaque in 4 (5%) cases; reclassifying 5 embolic strokes of uncertain source (28% of ESUS) to cardioembolic (CE, n = 3) and non-CE (n = 2) etiologies. LIE was identified in 38 (48%) patients, most commonly (82%) of ischemic pattern. We did not identify significant relationships between AIS etiology and the presence, pattern, and extent of LIE ( > 0.05); ECV ( = 0.56), severe aortic ( = 0.25) or valvular ( = 0.26) disease, or the extent of coronary calcification ( = 0.39). Patients with evidence of major cardiovascular DESCT findings had higher rates of all-cause death at 90 days (42% vs. 19%, = 0.037). In this study, hyperacute cardiac imaging of AIS with DESCT identified a high prevalence of incidental cardiac disease predominantly involving LIE of ischemic etiology and mostly not related to the stroke etiology.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1530-6550
DOI:	10.31083/j.rcm2303093