Advanced Cardiac Imaging In Patients With Ischemic Stroke. When To Scan? (P4.3-052)

Objective: To identify patient, TTE, electrocardiogram related variables associated with greater odds of detecting intracardiac thrombus using CCT and CMR Background: Advanced cardiac imaging(ACI) with cardiac CT (CCT) and cardiac MR (CMR) are valuable noninvasive investigative tools to assess cardiac structure in cryptogenic stroke assessment. In this study, we examine patient, electrocardiographic, and TTE variables associated with subsequent detection of intracardiac thrombus using CCT and CMR in patients with cryptogenic stroke. Design/Methods: The Medical University of South Carolina Comprehensive stroke center database was used to identify acute ischemic stroke patients who received inpatient CCT or CMR between January 2017 to May 2018. Patient demographics, past medical history, EKG, and TTE related variables were abstracted by 2 physicians. Univariate and multivariable logistic regression was used to identify factors associated with detection of intracardiac thrombus on CCT/CMR. Negative and positive predictive value were calculated for TTE, with CCT/CMR considered as gold standard. Results: 256 subjects received CCT/CMR after TTE during the study period; with 25 (9.7%) patients detected to have an intracardiac thrombus. Twelve (4.7%) patients had LV thrombus, 5 (2.3%) had LA thrombus, 4 (1.6%) had Myxoma tumor and 3 (1.2%) had valve thrombus. With regard TTE, 14 had positive imaging, 8 were true positive and 6 did not have intracardiac thrombus on CCT/CMR. The PPV and NPV of TTE was 57% and 93% respectively. Atrial fibrillation, P wave abnormality on EKG, ST changes on EKG and Left Ventricle wall motion abnormality on TTE and reduced EF% were associated with subsequent detection of intracardiac thrombus on CCT/CMR. Conclusions: Advanced cardiac imaging is a useful noninvasive tool in identifying cardiac source of ischemic stroke. Although small sample size and inadequate power may limit generalizability, patients with atrial fibrillation, P wave and ST changes on EKG, and LV wall motion akinesis should be considered for advanced cardiac imaging Disclosure: Dr. Orabi has nothing to disclose. Dr. Ajinkya has nothing to disclose. Dr. Suh has nothing to disclose. Dr. Girotra has nothing to disclose. Dr. Banerjee has nothing to disclose.