Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence Article Swipe
Georg Apfaltrer
,
Francesco Lavra
,
Carlo N. De Cecco
,
Ákos Varga‐Szemes
,
Marly van Assen
,
Domenico Mastrodicasa
,
Marco Scarabello
,
Marwen Eid
,
L. Parkwood Griffith
,
John W. Nance
,
Sheldon E. Litwin
,
Luca Saba
,
U. Joseph Schoepf
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.2214/ajr.20.23903
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.2214/ajr.20.23903
BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke. METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI (n = 75) or CCTA (n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC. RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different (p > .05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients. CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus. CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.2214/ajr.20.23903
- OA Status
- green
- Cited By
- 11
- References
- 32
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3085428326
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W3085428326Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.2214/ajr.20.23903Digital Object Identifier
- Title
-
Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke RecurrenceWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-09-16Full publication date if available
- Authors
-
Georg Apfaltrer, Francesco Lavra, Carlo N. De Cecco, Ákos Varga‐Szemes, Marly van Assen, Domenico Mastrodicasa, Marco Scarabello, Marwen Eid, L. Parkwood Griffith, John W. Nance, Sheldon E. Litwin, Luca Saba, U. Joseph SchoepfList of authors in order
- Landing page
-
https://doi.org/10.2214/ajr.20.23903Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://research.rug.nl/en/publications/1fcd4114-eed6-463a-882d-73ca8962d825Direct OA link when available
- Concepts
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Medicine, Cardiology, Stroke (engine), Internal medicine, Predictive value, Radiology, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
11Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2, 2024: 2, 2023: 1, 2022: 3, 2021: 3Per-year citation counts (last 5 years)
- References (count)
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32Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.as | 128, 344 |
| abstract_inverted_index.be | 317, 324, 354 |
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| abstract_inverted_index.75) | 96 |
| abstract_inverted_index.76) | 101 |
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| abstract_inverted_index.MRI | 66 |
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| abstract_inverted_index.NPV | 143, 183, 308 |
| abstract_inverted_index.TTE | 19, 69, 90, 156, 205, 217, 242, 252, 277, 294, 302, 345, 358 |
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| abstract_inverted_index.AUC. | 164 |
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| abstract_inverted_index.CMRI | 93, 176, 208, 237, 245, 283, 289, 315, 339 |
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| abstract_inverted_index.88.2% | 189 |
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| abstract_inverted_index.CMRI, | 153, 300 |
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| abstract_inverted_index.16.7%, | 201 |
| abstract_inverted_index.20.0%, | 213 |
| abstract_inverted_index.33.3%, | 185 |
| abstract_inverted_index.50.0%, | 187 |
| abstract_inverted_index.80.3%, | 193 |
| abstract_inverted_index.83.6%, | 200 |
| abstract_inverted_index.93.7%, | 186, 212 |
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| abstract_inverted_index.(CMRI), | 67 |
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| abstract_inverted_index.valvular | 126 |
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| abstract_inverted_index.suspected | 15, 75, 85 |
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| abstract_inverted_index.predicting | 347 |
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