Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;8(1):168-174.
doi: 10.1177/23969873221130838. Epub 2022 Oct 26.

Cardiac thrombi detected by CT in patients with acute ischemic stroke: A substudy of Mind the Heart

Leon A Rinkel  1 , Chiel Fp Beemsterboer  1 , Nina-Suzanne Groeneveld  1 , Nick Hj Lobé  2 , S Matthijs Boekholdt  3 , Berto J Bouma  3 , Fenna F Muller  1 , Ludo Fm Beenen  2 , Henk A Marquering  2   4 , Charles Blm Majoie  2 , Yvo Bwem Roos  1 , Adrienne van Randen  2 , R Nils Planken  2 , Jonathan M Coutinho  1
Affiliations

Cardiac thrombi detected by CT in patients with acute ischemic stroke: A substudy of Mind the Heart

Leon A Rinkel et al. Eur Stroke J. 2023 Mar.

Abstract

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.

Results: Among 452 included patients, cardiac CT detected 41 thrombi in 38 (8%) patients. Thrombi were most often located in the left atrial appendage (31/38 [82%]). Patients with a cardiac thrombus more frequently had intracranial occlusions in multiple vascular territories (5% vs 0.5%, p = 0.04) and a higher baseline NIHSS score (17 [IQR 6-22] vs 5 [IQR 2-3], p < 0.001) compared to patients 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.

Keywords: Acute stroke; cardiac emboli; computed tomography angiography.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CBLMM has received research grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation Dutch Health Evaluation program and Stryker (paid to institution). CBLMM, HAM and YBWEMR are shareholders of Nico.lab, a company that focuses on the use of artificial intelligence for medical image analysis. JMC reports grants from Medtronic, Boehringer Ingelheim, and Bayer outside the submitted work. (paid to institution). The other authors have no financial conflicts of interest.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flowchart of patients.
Figure 2.
Figure 2.
Functional outcome at 90 days.
See this image and copyright information in PMC

References

    1. Hart RG, Diener H-C, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–438. - PubMed
    1. Kamel H, Healey JS. Cardioembolic stroke. Circ Res 2017; 120: 514–526. - PMC - PubMed
    1. Egolum UO, Stover DG, Anthony R, et al. Intracardiac thrombus: diagnosis, complications and management. Am J Med Sci 2013; 345: 391–395. - PubMed
    1. Giruparajah M, Bosch J, Vanassche T, et al. Global survey of the diagnostic evaluation and management of cryptogenic ischemic stroke. Int J Stroke 2015; 10: 1031–1036. - PubMed
    1. Holmes M, Rathbone J, Littlewood C, et al. Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation. Health Technol Assess 2014; 18: 1–176. - PMC - PubMed