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Título

Cardiac Magnetic Resonance Imaging abnormalities are associated with stroke recurrence in patients with Embolic Stroke of Undetermined Source: a prospective cohort study

Resumo

Introduction: An unknown fraction of embolic strokes of undetermined source (ESUS) are thought to be cardioembolic. Previously published baseline data from this cohort showed that cardiac magnetic resonance imaging (CMRI) abnormalities are present in over one-quarter of ESUS patients, especially in patients with coronary artery disease or Chagas disease. However, it is not known if these CMRI abnormalities can affect the incidence of stroke recurrence.

Objectives: To identify the association between an abnormal CMRI and stroke recurrence.

Methods: Prospective cohort study. Participants were ≥ 18 years old, with previous ESUS according to the Causative Classification of Stroke. CMRI was performed at baseline, between 2012-2016. An abnormal CMRI was defined as the presence of wall fibrosis, wall edema, intracardiac thrombus or left ventricle aneurysm. Follow-up occurred every three months, using the Questionnaire for Verifying Stroke-Free Status and neurologic evaluation with neuroimaging to identify stroke recurrence. Survival analysis was performed for the primary outcome.

Results: Follow-up was obtained from 30 (61%) out of 49 normal CMRI and 13 (77%) out of 17 abnormal CMRI patients. Baseline clinical characteristics were similar for both groups except for a higher frequency of Chagas disease among patients with abnormal CMRI (46% versus 17%). Mean age was 52 ± 15 and 23 (53,3%) were female. No patient had coronary artery disease. Mean follow-up time was 75 ± 21 months for abnormal CMRI and 81 ± 24 months for normal CMRI. Stroke recurrence incidence was 39.8 (IC95% 8-116) per 1000 patient-years if CMRI was abnormal and 5 (IC95% 0-28) per 1000 patient-years if CMRI was normal (log-rank test: p=0.04). Regarding health status during follow-up, anticoagulation was started in 5 (38%) patients with abnormal CMRI and 1 patient (3%) with normal CMRI (p=0.03). We noticed no difference in emergency department visits or atrial fibrillation diagnosis during follow-up.

Conclusion: An abnormal CMRI is associated with higher stroke recurrence in ESUS patients, suggesting that this method may be useful to further stratify stroke risk in patients with ESUS.

Palavras Chave

Stroke, Embolic Stroke, Cardiac Magnetic Resonance Imaging