BACKGROUND: Embolic stroke of unknown source (ESUS) accounts for 1 in 6 ischemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS, and beyond the identification of cardioembolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and noncardiac findings and to determine their impact on clinical care in patients with ESUS.METHODS AND RESULTS: In this prospective, multicenter, observational study, CMR imaging 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 imaging. 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 extracardiac 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 noncardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04555538.
Kotadia, ID, O'Dowling, R, Aboagye, A, Crawley, RJ, Bodagh, N, Gharaviri, A, O'Hare, D, Solis-Lemus, JA, Roney, CH, Sim, I, Ramsey, D, Newby, D, Chiribiri, A, Plein, S, Sztriha, L, Scott, P, Masci, P-G, Harrison, J, Williams, MC, Birns, J, Somerville, P, Bhalla, A, Niederer, S, O'Neill, M & Williams, SE 2024, 'High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging', Journal of the American Heart Association, vol. 13, no. 3, e031489, pp. 1-11. https://doi.org/10.1161/JAHA.123.031489
Kotadia, I. D., O'Dowling, R., Aboagye, A., Crawley, R. J., Bodagh, N., Gharaviri, A., O'Hare, D., Solis-Lemus, J. A., Roney, C. H., Sim, I., Ramsey, D., Newby, D., Chiribiri, A., Plein, S., Sztriha, L., Scott, P., Masci, P.-G., Harrison, J., Williams, M. C., ... Williams, S. E. (2024). High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging. Journal of the American Heart Association, 13(3), 1-11. Article e031489. https://doi.org/10.1161/JAHA.123.031489
@article{02de8d38df1f497a97a4f79817abb7ef,
title = "High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging",
abstract = "BACKGROUND: Embolic stroke of unknown source (ESUS) accounts for 1 in 6 ischemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS, and beyond the identification of cardioembolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and noncardiac findings and to determine their impact on clinical care in patients with ESUS.METHODS AND RESULTS: In this prospective, multicenter, observational study, CMR imaging 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 imaging. 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 extracardiac 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 noncardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04555538.",
keywords = "Humans, Stroke/diagnostic imaging, Embolic Stroke, Prevalence, Prospective Studies, Magnetic Resonance Imaging, Intracranial Embolism/diagnostic imaging, Risk Factors",
author = "Kotadia, {Irum D} and Robert O'Dowling and Akosua Aboagye and Crawley, {Richard J} and Neil Bodagh and Ali Gharaviri and Daniel O'Hare and Solis-Lemus, {Jose Alonso} and Roney, {Caroline H} and Iain Sim and Deborah Ramsey and David Newby and Amedeo Chiribiri and Sven Plein and Laszlo Sztriha and Paul Scott and Pier-Giorgio Masci and James Harrison and Williams, {Michelle C} and Jonathan Birns and Peter Somerville and Ajay Bhalla and Steven Niederer and Mark O'Neill and Williams, {Steven E}",
note = "Funding Information: This study was funded by the British Heart Foundation (PG/19/44/34368). Dr Kotadia acknowledges support from the British Heart Foundation (FS/ CRTF/21/24166). Dr S. E. Williams acknowledges support from the British Heart Foundation (FS/20/26/34952). Professor Plein was funded by the British Heart Foundation under grant CH/16/2/32089. This work was supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/ Z/16/Z). Dr M. C. Williams is supported by the British Heart Foundation (FS/ ICRF/20/26002). The authors acknowledge the support of the British Heart Foundation Centre for Research Excellence Award III (RE/18/5/34216). Publisher Copyright: {\textcopyright} 2024 The Authors.",
year = "2024",
month = feb,
day = "6",
doi = "10.1161/JAHA.123.031489",
language = "English",
volume = "13",
pages = "1--11",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley",
number = "3",
}