PMID- 38484943
OWN - NLM
STAT- MEDLINE
DCOM- 20240510
LR  - 20240510
IS  - 1532-8511 (Electronic)
IS  - 1052-3057 (Linking)
VI  - 33
IP  - 6
DP  - 2024 Jun
TI  - Assessing left atrial size and pump function in ischemic stroke patients: Is 
      cardiac MRI superior to transthoracic echocardiography?
PG  - 107674
LID - S1052-3057(24)00119-8 [pii]
LID - 10.1016/j.jstrokecerebrovasdis.2024.107674 [doi]
AB  - OBJECTIVES: Current guidelines recommend transthoracic echocardiography (TTE) 
      following an ischemic stroke as the primary technique to identify cardiac 
      abnormalities associated with an increased risk of cerebral embolism. It is 
      unclear whether cardiac magnetic resonance imaging (cMRI), a technique shown to 
      provide increased imaging resolution, may also enhance the cardiac assessment of 
      ischemic stroke patients. We compared cMRI with TTE in the evaluation of Left 
      Atrial (LA) size and pump function in a cohort of 44 patients with ischemic 
      stroke. MATERIALS AND METHODS: The biplane method was utilized to acquire LA 
      diameters as well as area measurements in both TTE and cMRI. We calculated LA 
      volume (LAV), LAV index (LAVI), LA Global Longitudinal Strain (GLS) and LA pump 
      function. Results were compared using paired two sample for means t-test. Lin's 
      concordance correlation coefficient (CCC) and Bland-Altman methods quantified the 
      agreement of measurements obtained by TTE and cMRI. RESULTS: LAVI measurements by 
      cMRI were significantly larger (34.97 v. 28.81; p = 0.001) than by TTE. The 
      concordance correlation demonstrated only a weak agreement between LA size 
      measured by cMRI and TTE (rhoc = 0.397; p= 0.001, 95% CI 0.16 - 0.59), and the 
      Bland-Altman plot demonstrated that LAVI measured by cMRI averaged 6.3 ml/m(2) 
      larger magnitude than those obtained by TTE. CONCLUSIONS: Using TTE alone leads 
      to an underestimation of LA abnormalities important in the evaluation of ischemic 
      stroke patients. Nearly one in every five ischemic stroke patients evaluated 
      based on the current guidelines may have a missed potential source of cardiac 
      embolism.
CI  - Copyright (c) 2024. Published by Elsevier Inc.
FAU - Isaac, Maxwell
AU  - Isaac M
AD  - The Division of Cardiology, Department of Medicine.
FAU - Kumar, Senthil A
AU  - Kumar SA
AD  - The Division of Cardiology, Department of Medicine.
FAU - Petroski, Gregory F
AU  - Petroski GF
AD  - The Office of Medical Research, Biostatistics Unit.
FAU - Shinn, Alex
AU  - Shinn A
AD  - The Division of Cardiology, Department of Medicine.
FAU - Mehra, Ashir
AU  - Mehra A
AD  - The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, 
      Missouri, USA. Electronic address: ashir.mehra@health.missouri.edu.
FAU - Gomez, Camilo R
AU  - Gomez CR
AD  - The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, 
      Missouri, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20240312
PL  - United States
TA  - J Stroke Cerebrovasc Dis
JT  - Journal of stroke and cerebrovascular diseases : the official journal of National 
      Stroke Association
JID - 9111633
SB  - IM
MH  - Humans
MH  - Female
MH  - Male
MH  - *Ischemic Stroke/diagnostic imaging/physiopathology
MH  - *Atrial Function, Left
MH  - Aged
MH  - Middle Aged
MH  - *Heart Atria/diagnostic imaging/physiopathology
MH  - *Predictive Value of Tests
MH  - Reproducibility of Results
MH  - *Echocardiography
MH  - Magnetic Resonance Imaging
MH  - Aged, 80 and over
OTO - NOTNLM
OT  - Cardiac MRI
OT  - Cardioembolic stroke
OT  - Ischemic stroke
OT  - Transthoracic echocardiography
COIS- Declaration of competing interest None.
EDAT- 2024/03/15 00:43
MHDA- 2024/05/11 08:43
CRDT- 2024/03/14 20:27
PHST- 2023/11/07 00:00 [received]
PHST- 2024/02/22 00:00 [revised]
PHST- 2024/03/04 00:00 [accepted]
PHST- 2024/05/11 08:43 [medline]
PHST- 2024/03/15 00:43 [pubmed]
PHST- 2024/03/14 20:27 [entrez]
AID - S1052-3057(24)00119-8 [pii]
AID - 10.1016/j.jstrokecerebrovasdis.2024.107674 [doi]
PST - ppublish
SO  - J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107674. doi: 
      10.1016/j.jstrokecerebrovasdis.2024.107674. Epub 2024 Mar 12.