Key result
CT-detected cardiac thrombus in acute ischemic stroke is linked to ~218% higher odds of worse 90-day outcomes.
Why the study?
Cardiac thrombi are a major risk factor for ischemic stroke but are rarely diagnosed in the acute phase.
Does the presence of a cardiac thrombus detected by acute-phase cardiac CT worsen functional outcome or increase stroke recurrence in patients with acute ischemic stroke?
Cohort (n=452)
No
Does the presence of a cardiac thrombus detected by acute-phase cardiac CT worsen functional outcome or increase stroke recurrence in patients with acute ischemic stroke?
In patients with acute ischemic stroke, the presence of a cardiac thrombus detected by acute-phase cardiac CT is associated with more severe deficits and worse functional outcomes at 90 days.
Answers are grounded in this paper and cite their sources.
Cardiac thrombus on acute CT identifies higher-risk ischemic stroke patients; leaves open whether detection should alter antithrombotic management.
Background: Cardiac thrombi are a major risk factor for ischemic stroke, but are rarely diagnosed in the acute phase. We examined characteristics and functional outcome of patients with ischemic stroke and a concomitant cardiac thrombus detected on cardiac CT performed in the acute phase. Patients and Methods: We used data from "Mind the Heart," a prospective cohort study in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during their acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale) and stroke recurrence rate at 90 days of patients with a cardiac thrombus on CT (defined as filling defect <100 Hounsfield Units) to those without a cardiac thrombus. In 13/38 (34%) patients with a cardiac thrombus, no atrial fibrillation was detected. A cardiac thrombus was associated with worse functional outcome (adjusted common odds ratio 3.18 95%CI 1.68-6.00). Recurrence rate was not significantly different (8% vs 4%, aOR 1.50 (0.39-5.82). Discussion and Conclusion: Cardiac CT detected a cardiac thrombus in one in every 12 patients with acute ischemic stroke, and these patients had more severe deficits, multivessel occlusions, and a worse functional outcome.
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Rinkel et al. (2022) conducted a cohort in Acute ischemic stroke (n=452). Presence of cardiac thrombus on CT vs. Absence of cardiac thrombus on CT was evaluated on Worse functional outcome (shift on modified Rankin Scale at 90 days) (aOR 3.18, 95% CI 1.68-6.00). The presence of a cardiac thrombus detected on CT in patients with acute ischemic stroke was associated with a significantly worse functional outcome at 90 days (aOR 3.18).
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