Cardiac Source Research Articles

Abstract P299: Heart Brain Clinic: Integrated Management of Ischemic Stroke

Background: About 25% of acute ischemic strokes (IS) are categorized into stroke of undetermined etiology and many ultimately have a cardiac source for stroke. Neurologists and cardiologists can improve decision making, as has been shown with other multidisciplinary clinics. We report our experience in creating our Heart Brain Clinic (HBC) with a focus on patients with patent foramen ovale (PFO). Methods: Demographic and clinical data were collected retrospectively for patients with PFO evaluated for IS in the inpatient or outpatient setting. Patients were divided into routine care and HBC groups. We compared time from stroke to PFO closure and number of clinic visits prior to decision about closure. Nonparametric analysis was used to calculate difference between medians, while chi square test was used for categorical values. Results: HBC began in 12/2018 with coordination of administrative and staffing efforts between neurology and cardiology departments. From 2/17 to 7/20, 73 patients were evaluated for PFO (42 routine care, 31 HBC; Table 1). At the time of data analysis, 67 patients had received recommendations about PFO closure and 52 patients underwent PFO closure. More than 50% of all patients traveled from outside Houston. HBC patients required fewer clinic visits (p=0.023) prior to decision about closure; however, in patients who underwent PFO closure, there was no difference in weeks from stroke to closure. Patients seen in HBC were recommended to not undergo closure more often than routine care (p= 0.007) Conclusions: Our data demonstrates that a multidisciplinary, patient-centered approach to management of IS patients with PFO is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of healthcare.

Engineering Human Cardiac Muscle Patch Constructs for Prevention of Post-infarction LV Remodeling.

Tissue engineering combines principles of engineering and biology to generate living tissue equivalents for drug testing, disease modeling, and regenerative medicine. As techniques for reprogramming human somatic cells into induced pluripotent stem cells (iPSCs) and subsequently differentiating them into cardiomyocytes and other cardiac cells have become increasingly efficient, progress toward the development of engineered human cardiac muscle patch (hCMP) and heart tissue analogs has accelerated. A few pilot clinical studies in patients with post-infarction LV remodeling have been already approved. Conventional methods for hCMP fabrication include suspending cells within scaffolds, consisting of biocompatible materials, or growing two-dimensional sheets that can be stacked to form multilayered constructs. More recently, advanced technologies, such as micropatterning and three-dimensional bioprinting, have enabled fabrication of hCMP architectures at unprecedented spatiotemporal resolution. However, the studies working on various hCMP-based strategies for in vivo tissue repair face several major obstacles, including the inadequate scalability for clinical applications, poor integration and engraftment rate, and the lack of functional vasculature. Here, we review many of the recent advancements and key concerns in cardiac tissue engineering, focusing primarily on the production of hCMPs at clinical/industrial scales that are suitable for administration to patients with myocardial disease. The wide variety of cardiac cell types and sources that are applicable to hCMP biomanufacturing are elaborated. Finally, some of the key challenges remaining in the field and potential future directions to address these obstacles are discussed.

The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit.

Background and purpose—current guidelines recommend the use of transesophageal echocardiography (TEE) in relation to cardio-embolic sources of stroke. Methods—by using an hospital-based cohort, we retrospectively analyzed consecutive patients with acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA) who were admitted in Strasbourg Stroke Center, France between November 2017 to December 2018. TEE reports were screened for detection of potential cardiac sources of embolism and the subsequent change in medical management. We performed univariate and multivariate analyses to identify predictors of relevant TEE findings. Results-out of the 990 patients admitted with confirmed stroke, 432 patients (42.6%) underwent TEE. Patients with TEE were younger (62.8 ± 14.8 vs. 73.8, p < 0.001), presented less comorbidities and lower stroke severity assessed by lower NIHSS (2 IQR (0–4) vs. 3 IQR (0–10), p < 0.01) and Modified Rankin Scale (1 IQR (0–1) vs. 1 (0–3), p < 0.01). A total of 227 examinations (52.5%) demonstrated abnormal findings considered as potential cardiac sources of embolism and 31 examinations (7.1%) were followed by subsequent change in medical management. Age (HR: 0.948, 95% CI 0.923 to 0.974; p < 0.001), previous AIS (HR: 3.542, 95% CI 1.290 to 9.722; p = 0.01), previous TIA (HR: 7.830, CI 95% 2214 to 27,689; p = 0.001) and superficial middle cerebral artery territory infarction (HR: 2.774, CI 95% 1.168–6.589; p = 0.021) were strong independent predictors with change in medical management following TEE. Conclusions—additional TEE changed the medical course of stroke patients in 7.1% in a French high-volume stroke unit.

57-Year-Old Woman With Weakness and Word-Finding Difficulties

57-Year-Old Woman With Weakness and Word-Finding Difficulties

Can Visual Function Be Affected by an Open Foramen Ovale?

The authors present a relatively rare finding of pathological changes in the visual field, the emergence of homonymous hemianopia, in connection with trauma and paradoxical embolism in a subsequently diagnosed open foramen ovale in a 56-year-old otherwise healthy patient. Cardiac source of embolism is a significant etiology of vascular embolization. The important group is the so-called paradoxical embolism, which occurs when a blood clot (embolus) is carried from the venous side of circulation to the arterial side via foramen ovale patens, what can manifests as ischemic stroke. Foramen ovale patens becomes a risk factor for the stroke development only if there is a peripheral source of embolism and at the same time there is a hemodynamically significant right-left short circuit. Therefore, screening for the causes of cryptogenic stroke should include not only the detection of foramen ovale patens but also evaluation of the peripheral venous system, coagulation parameters and hemodynamic severity of a right-left shunt. Neuroophthalmological aspects related to the described issues are discussed.

Electrocardiographic and Echocardiographic Abnormalities in Patients with Risk Factors for Atrial Fibrillation.

The electrocardiogram and various echocardiography modalities are important risk markers for atrial fibrillation (AF). Electrocardiographic criteria of left atrial enlargement, advanced interatrial block, and PR-interval prolongation are atrial risk markers for AF. Transthoracic echocardiography is elementary for risk stratification of AF. Transesophageal echocardiography is a valuable tool to detect cardiac sources of embolism if early cardioversion is necessary. Intracardiac echocardiography is a real-time tool for guidance of percutaneous interventions, including radiofrequency ablation and left atrial appendage closure in patients with AF.

Simultaneous Multi-Heartbeat ECGI Solution with a Time-Varying Forward Model: a Joint Inverse Formulation.

Electrocardiographic imaging (ECGI) is an effective tool for noninvasive diagnosis of a range of cardiac dysfunctions. ECGI leverages a model of how cardiac bioelectric sources appear on the torso surface (the forward problem) and uses recorded body surface potential signals to reconstruct the bioelectric source (the inverse problem). Solutions to the inverse problem are sensitive to noise and variations in the body surface potential (BSP) recordings such as those caused by changes or errors in cardiac position. Techniques such as signal averaging seek to improve ECGI solutions by incorporating BSP signals from multiple heartbeats into an averaged BSP with a higher SNR to use when estimating the cardiac bioelectric source. However, signal averaging is limited when it comes to addressing sources of BSP variability such as beat to beat differences in the forward solution. We present a novel joint inverse formulation to solve for the cardiac source given multiple BSP recordings and known changes in the forward solution, here changes in the heart position. We report improved ECGI accuracy over signal averaging and averaged individual inverse solutions using this joint inverse formulation across multiple activation sequence types and regularization techniques with measured canine data and simulated heart motion. Our joint inverse formulation builds upon established techniques and consequently can easily be applied with many existing regularization techniques, source models, and forward problem formulations.

Impact of early transesophageal echocardiography on therapeutic management of patients with acute embolic strokes of undetermined source (ESUS)

Up to one-fourth of ischemic strokes remain cryptogenic after standard evaluation. The ESUS concept for embolic strokes of undetermined source was defined in 2014, the patients being supposed to benefit from anticoagulation, but the studies are negative as of this date. Transthoracic and transesophageal (TEE) echocardiography are the main diagnostic tools for cardiac and aortic sources of embolism, the second being superior. However, its therapeutic impact is not fully determined, since it is not recommended in ESUS. We aimed to assess prospectively, in consecutive ESUS patients admitted to our stoke unit, the rate of treatment change induced by transesophageal echocardiography (TEE), and to identify predictive factors for such modifications. Acute ESUS patients were prospectively included to undergo TEE within seven days. Demographic, laboratory, MRI and echocardiographic data were recorded. The primary endpoint was the rate of TEE induced therapeutic modification. Between October 2016 and May 2018, 154 ESUS patients entered the analyses. TEE changed the treatment in 22 patients (14.3%): anticoagulation in 7, cardiac surgery in 2, dual antiplatelet therapy for complex aortic arch atheroma in 10, antibiotics in 2 and atrial septal defect closure in 1. Patients with TEE induced treatment modification were significantly older (68.9 vs. 59.0 years, P < 0.001), and had more vascular risk factors: diabetes mellitus (36.4% vs. 15.9%, P = 0.036), hypertension (68.2% vs. 43.9%, P = 0.035), hypercholesterolemia (72.7% vs. 28.8%, P < 0.001) and more CRP (63.6% vs. 33.3%, P = 0.007), hs Troponin I (50.0% vs. 22.7%, P = 0.007) and NT-pro-BNP (31.8% vs. 9.8%, P = 0.011) elevation. There was a trend to more multiple infarcts on DWI MRI in treatment change group (50.0% vs. 31.8%, P = 0.097). TEE lead to a treatment modification in 14% of cases. Selected ESUS patients may benefit from TEE.

Transesophageal echocardiogram in the evaluation of acute ischemic stroke of young adults

INTRODUCTION:Acute ischemic stroke (AIS) in the young age (≤50 years) is a major cause of disability. The underlying mechanism of AIS in this age group is usually different from elderly. Transthoracic echocardiography (TTE) is used to detect the potential cardiac sources of embolism in AIS patients. Transthoracic echocardiogram (TEE) is superior to detect specific underlying cardio-aortic source of embolism when compared to TTE. We aim to evaluate the diagnostic yield and therapeutic impact of TEE in AIS of young adults.METHODS:We retrospectively reviewed the consecutive patients with AIS in our comprehensive center in a 5-year period from our prospectively collected registry. We selected patients with age ≤50 years who had acute infarcts on brain magnetic resonance imaging or head computed tomography and underwent TEE as part of their diagnostic workup. Demographic details including, age, gender, body mass index, cardiovascular risk factors profile, and TEE findings were collected.RESULTS:Among a total 7,930 patients, 876 (11.04%) were found to be ≤50 years old. Among those, TEE was done in 113 patients (12.8%) in addition to TTE. Those who underwent TEE had a mean age of 40.4 ± 7.9 years, 60 were male (53%), 7 (6.2%) had a history of coronary artery disease, 38 (33%) had a history of diabetes, and 45 (40%) had a history of smoking. TEE showed new abnormal findings in a total of 15 patients (13.2%) that were not reported in their TTEs. Out of these, left atrial appendage thrombus was found in 5, infective endocarditis in 4, atrial septal aneurysms associated with patent foramen ovale (PFO) in 3, and spontaneous mobile echo density in three patients. Overall, new findings from TEE resulted in change in the secondary stroke prevention strategy in 14 patients of those who underwent TEE (12.3%). TEE also confirmed the presence of PFO, which was present on TTE with bubble study in 20 (17.6%) patients.CONCLUSION:TEE may provide additional information in the evaluation of the AIS in young adults, which could lead to change of the secondary stroke prevention strategy.

Protective and anti-inflammatory effects of acetylcholine in the heart.

The innate and adaptive immune systems play an important role in the development of cardiac diseases. Therefore, it has become critical to identify molecules that can modulate inflammation in the injured heart. In this regard, activation of the cholinergic system in animal models of heart disease has been shown to exert protective actions that include immunomodulation of cardiac inflammation. In this mini-review, we briefly present our current understanding on the cardiac cellular sources of acetylcholine (ACh) (neuronal vs. nonneuronal), followed by a discussion on its contribution to the regulation of inflammatory cells. Although the mechanism behind ACh-mediated protection still remains to be fully elucidated, the beneficial immunomodulatory role of the cholinergic signaling emerges as a potential key regulator of cardiac inflammation.

Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faustian bargain for left atrial appendage closure?

Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faustian bargain for left atrial appendage closure?

The radiofrequency interference on CRT-D functioning during AV node ablation: An educational case.

We have described some unusual findings of radiofrequency interference with ICD functioning during AV nodal ablation, guiding the reader to the possible explanation of the phenomena.

Abstract 16206: An Atypical Presentation of Spontaneous Coronary Artery Dissection in a Young Male Patient

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in women but rare in young healthy males. We report a case of a young male who presented with left hand tingling/numbness and was ultimately diagnosed with SCAD. Case Presentation: A 24-year-old male with history of asthma developed left hand tingling/numbness while playing basketball. This progressed to cold left upper extremity, prompting him to go to emergency room. Doppler ultrasound showed acute left brachial thrombus and emergent embolectomy of left brachial artery was done. Transesophageal echocardiogram, performed to investigate possible cardiac source of thrombus, showed normal ejection fraction, dyskinetic apex and biventricular thrombus (Figure 1A). Cardiac MRI revealed a large transmural MI in distribution of a wraparound left anterior descending artery (LAD) with associated regional akinesis of the left ventricular apex and an infarct in the right ventricular apex. Subsequent angiography revealed normal coronary arteries (Figure 1B) except a heterogenous linear filling defect in the apical LAD consistent with Type 1 SCAD (Figure 1C). No intervention was performed and the patient was treated conservatively. It was postulated that patient sustained an apical MI after SCAD of LAD, leading to formation of ventricular thrombi which then embolized to cause acute brachial artery thrombosis. Discussion: SCAD in young males is rare and can be a diagnostic challenge. Type 1 “pathognomic” angiographic finding in SCAD, is the classic appearance of multiple radiolucent lumens or arterial wall contrast staining. In case of inconclusive angiography, intravascular ultrasound or optical computed tomography can confirm diagnosis. Interventionalists should be familiar with angiographic appearance of SCAD as advanced imaging might not be available and in many cases, conservative management is preferred to percutaneous coronary intervention.

Cardiac sources of cerebral embolism in people with migraine.

Whether the reported association between migraine with aura (MA) and cardioembolic stroke may be explained by a higher rate of atrial fibrillation (AF) or by other potential cardiac sources of cerebral embolism remains to be determined. In the setting of a single centre cohort study of consecutive patients with acute brain ischaemia stratified by migraine status, the association between AF as well as patent foramen ovale (PFO) and migraine was explored. In all, 1738 patients (1017 [58.5%] men, mean age 67.9±14.9years) qualified for the analysis. Aging was inversely associated with migraine, whilst women had a >3-fold increased disease risk (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.58-5.66). No association between AF and history of migraine or its pathogenic subtypes was detected. Conversely, migraine was associated with PFO, both in the entire cohort (OR 1.84, 95% CI 1.07-3.16) and in patients aged ≤55years (OR 2.21, 95% CI 1.16-4.22). This association was significant for MA (OR 2.92, 95% CI 1.32-6.45 in the entire cohort; OR 2.92, 95% CI 1.15-7.41 in patients aged ≤55years) and in women (OR 8.23, 95% CI 2.06-32.77), but not for migraine without aura. In patients with brain ischaemia migraine is not associated with AF. Conversely, there is a probable relation between migraine, especially MA, and PFO in patients who are younger and have a more favourable vascular risk factor profile, and in women.

Improved ICA algorithm for ECG feature extraction and R‐peak detection

SummaryElectrocardiogram (ECG) signal transmission and monitoring plays a paramount role in long‐term cardiac monitoring and analysis to provide remote health care in time, especially for the postoperative people and people in remote areas. The accuracy of ECG signals is of fundamental importance in cardiac diagnosis like R‐peak detection. So we need to incorporate analytical methods in existing healthcare systems, to capture more meaningful ECG components and to represent physical cardiac sources more clearly. With this aim, hardware optimized FCAICA (fast confluence adaptive independent component analysis) algorithm is proposed to extract pure ECG components from the ECG mixtures. The extracted signals are then subjected to R‐peak detection for further analysis. The proposed improved fast confluence adaptive independent component analysis (IFCAICA) method occupies less hardware resources, consumes low power, improves accuracy, and sensitivity in R‐peaks detection. In 0.18 nm technology, the IFCAICA consumes 10.13 mW of power and operates with 3.4 MHz operating frequency.

An in vitro assessment of atrial fibrillation flow types on cardiogenic emboli trajectory paths.

Atrial fibrillation is the most significant contributor to thrombus formation within the heart and is responsible for 45% of all cardio embolic strokes, which account for approximately 15% of acute ischemic strokes cases worldwide. Atrial fibrillation can result in a reduction of normal cardiac output and cycle length of up to 30% and 40%, respectively. A total of 240 embolus analogues were released into a thin-walled, patient-specific aortic arch under normal (60 embolus analogues) and varying atrial fibrillation (180 embolus analogues) pulsatile flow conditions. Under healthy flow conditions (n = 60), the embolus analogues tended to follow the flow rate split through each outlet vessel. There was an increase in clot trajectories along the common carotid arteries under atrial fibrillation flow conditions. A shorter pulse period (0.3 s) displayed the highest percentage of clots travelling to the brain (24%), with a greater percentage of clots travelling through the left common carotid artery (17%). This study provides an experimental insight into the effect varying cardiac output and cycle length can have on the trajectory of a cardiac source blood clots travelling to the cerebral vasculature and possibly causing a stroke.

Abstract 227: Lack of Beta-carotene 9’,10’ Diooxygenase (Bco2) Impacts Cardiac Postnatal Growth and Energy Metabolism in Female Mice

As the postnatal heart grows it also undergoes critical metabolic adaptations to use mainly lipids rather than carbohydrates as energy-providing substrates. Abnormal growth patterns and lack of metabolic flexibility are pathological responses of the heart that lead to cardiovascular diseases (CVD). Carotenoids, such as β-carotene - the most abundant dietary precursor of vitamin A - have been linked to the prevention of CVD. In the heart, β-carotene can be metabolized to retinoids and other apo-carotenoids by the action of β-carotene 9’,10’-dioxygenase (BCO2). We found that Bco2 -/- female mice have significantly smaller hearts than wild-type (WT), pre- and post-puberty. Echocardiography revealed a significant increase in aortic blood flow velocity with no change in overall cardiac output. This analysis also suggests that the mutant has a smaller left ventricle with thinner walls. In addition, expression of cardiac foetal genes (BNP, α-Skeletal actinin and β-MyHc ), typically upregulated during embryogenesis or under pathological conditions in the adult, were significantly increased in the mutant. Bco2 -/- females showed impaired exercise capacity, displaying a ~40% reduction in running distance compared to WT. These data indicate functional cardiac defects in the mutant under stress conditions. Bco2 -/- females also displayed impaired cardiac metabolic flexibility. We found that Bco2 -/- mice have reduced Pdk4 expression and thus enhanced PDH activity. Cardiac expression of Glut1 and Mct1, key glucose and lactate transporters , were significantly higher in Bco2 -/- females, while triglyceride levels were lower in the heart and serum. These findings suggest preferential use of glucose as a cardiac energy source. Interestingly, the mutants had reduced cardiac retinoic acid levels (by LC-MS analysis) compared to WT. Retinoic acid upregulates Pdk4 , thus we postulated that retinoic acid deficiency contributes to loss of cardiac metabolic flexibility in Bco2 -/- females. Ongoing studies aim to confirm this hypothesis and determine if altered retinoic acid homeostasis is also linked to impaired postnatal heart growth in mutant mice. These findings give new insights into a potential role of the β-carotene metabolic pathway in regulating adult heart function.

RETRACTED: Interleukin-22 deficiency alleviates doxorubicin-induced oxidative stress and cardiac injury via the p38 MAPK/macrophage/Fizz3 axis in mice

Several interleukin (IL) family members have been demonstrated to be involved in doxorubicin (DOX)-induced cardiac injury. This study aimed to investigate the role of IL-22 in DOX-induced cardiac injury and explore its possible mechanisms. In this study, mice were given DOX, and the cardiac expression and sources of IL-22 were determined. Then, IL-22 was knocked out to observe the effects on DOX-induced cardiac injury in mice. In addition, the p38 mitogen-activated protein kinase (MAPK) pathway was inhibited, macrophages were depleted and adoptively transferred, and Fizz3 was up-regulated in mice to explore the mechanisms. The results showed that cardiac IL-22 expression was significantly increased by DOX treatment and was mostly derived from cardiac macrophages. IL-22 knockout significantly reduced cardiac vacuolization and the expression of cardiomyocyte injury markers in both serum and left ventricular tissue and improved cardiac function in DOX-treated mice. In addition, IL-22 knockout reversed DOX-induced cardiac M1 macrophage/M2 macrophage imbalance, reduced oxidative stress and protected against cardiomyocyte apoptosis. p38 MAPK pathway inhibition with SB203580 and macrophage depletion further alleviated the above effects in DOX-treated IL-22-knockout mice. The effects were stronger IL-22-knockout mice with adoptive transfer of WT macrophages than in those with adoptive transfer of IL-22-knockout macrophages. Furthermore, increasing the expression of Fizz3 reduced cardiomyocyte apoptosis and alleviated cardiac dysfunction. Our results may suggest that IL-22 knockout alleviate DOX-induced oxidative stress and cardiac injury by inhibiting macrophage differentiation and thereby increasing the expression of Fizz3. Reductions in IL-22 expression may be beneficial for clinical chemotherapy in tumor patients.

Nonparametric targeted Bayesian estimation of class proportions in unlabeled data.

We introduce a novel Bayesian estimator for the class proportion in an unlabeled dataset, based on the targeted learning framework. The procedure requires the specification of a prior (and outputs a posterior) only for the target of inference, and yields a tightly concentrated posterior. When the scientific question can be characterized by a low-dimensional parameter functional, this focus on target prior and posterior distributions perfectly aligns with Bayesian subjectivism. We prove a Bernstein-von Mises-type result for our proposed Bayesian procedure, which guarantees that the posterior distribution converges to the distribution of an efficient, asymptotically linear estimator. In particular, the posterior is Gaussian, doubly robust, and efficient in the limit, under the only assumption that certain nuisance parameters are estimated at slower-than-parametric rates. We perform numerical studies illustrating the frequentist properties of the method. We also illustrate their use in a motivating application to estimate the proportion of embolic strokes of undetermined source arising from occult cardiac sources or large-artery atherosclerotic lesions. Though we focus on the motivating example of the proportion of cases in an unlabeled dataset, the procedure is general and can be adapted to estimate any pathwise differentiable parameter in a non-parametric model.

Cardiovascular MRI: A valuable tool to detect cardiac source of emboli in cryptogenic ischemic strokes.

ObjectivesDespite a thorough work‐up including transesophageal echocardiography, 20%–30% of stroke etiology remains cryptogenic. Transesophageal echocardiogram is considered the gold standard procedure to detect cardiac or aortic sources of emboli. In the recent years, cardiovascular MRI has emerged as a noninvasive, sound, and reliable modality to image morphological and functional abnormalities. In this study, we compared none contrast cardiovascular MRI to transesophageal echocardiogram, in the ability to detect cardiovascular source of embolus in cryptogenic ischemic strokes.MethodsA series of 24 patients who were labeled, after a thorough stroke work‐up, as having cryptogenic stroke, were examined with both transesophageal echocardiogram and noncontrast cardiovascular MRI to assess for cardiac or aortic source of emboli. The cardiologist who interpreted the transesophageal echocardiograms was blinded to the results of cardiovascular MRI. At the same time, the radiologist who interpreted the cardiovascular MRI was also blinded to the results of transesophageal echocardiogram. The cardiac lesions, with potential source of emboli that were assessed in our study included left ventricular thrombus, atrial septal aneurysm, and aortic atherosclerotic disease. The ability of cardiovascular MRI to identify potential source of cardiac embolus was then compared to that of transesophageal echocardiogram.ResultsTransesophageal echocardiogram detected ascending or arch aortic atherosclerotic plaque in 14 of the 24 patients. Other abnormalities detected include two atrial septal aneurysms and two left ventricular thrombus. Cardiovascular MRI was able to identify aortic atheroma in 13 patients; as well as three atrial septal aneurysms and two left ventricular thrombus. The accuracy of cardiovascular MRI to detect aortic atheroma, atrial septal aneurysm or left ventricular thrombus was great; 96%, 95.83%, and 100%, respectively.ConclusionThis small study suggests that, in patients with cryptogenic stroke, cardiovascular MRI is comparable to transesophageal echocardiogram in detecting cardiac and aortic source of emboli.