Abstract
Objective: Although anticoagulants are recommended in patients with left ventricular (LV) thrombi following myocardial infarction (MI) or LV dysfunction for preventing ischemic stroke, it remains unknown what imaging modality is useful. We sought to detect LV thrombi in acute ischemic stroke patients using contrast-enhancement cardiac magnetic resonance (CE-CMR). Methods: Between February and July 2014, 232 consecutive patients with acute ischemic stroke were admitted to our stroke center within 48 hours after the onset. Among them, patients with a prior MI or systolic LV dysfunction (LV ejection fraction [LVEF] <50%) were prospectively enrolled. CE-CMR and conventional transthoracic echocardiography (TTE) were performed within 7 days from admission. Clinical characteristics and parameters of CE-CMR were analyzed to predict LV thrombus. Results: Twenty-two patients (18 men, 74±12 years old) were enrolled. They consisted of 14 (64%) patients with a prior MI and 8 (36%) patients with LV dysfunction. Two (9%) patients had been treated with anticoagulants before the onset of stroke. The stroke subtypes were classified as follows; cardioembolism in 16 (73%), large-artery atherosclerosis in 3 (14%), small-vessel occlusion in 1 (4%), and others in 2 (9%). LV thrombus was identified in 4 patients (18%) by CE-CMR, whereas only 1 patient was detected by TTE. The locations of LV thrombi were apex (n=2), inferior wall (n=1), and lateral wall (n=1), respectively. Patients with LV thrombus had significantly larger LV end-diastolic (275±89 vs. 182±55ml, p = 0.011) and end-systolic volumes (229±88 vs. 114± 52ml, p = 0.009), and lower LVEF (18±6 vs. 40±11%, p = 0.006) than those without. Conclusion: In acute ischemic stroke patients with prior MI or LV dysfunction, CE-CMR was a useful tool for detecting LV thrombus in comparison with TTE. CE-CMR could identify the patients who need anticoagulant therapy.
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