Citations 2
Diagnostic Yield of Cardiac CT to Detect Cardiac Thrombi in Patients With Acute Ischemic Stroke (AIS of HEARTS)
Nio, Shan Sui , Green, Daniel S. , Berry-Noronha, Alexander , Rinkel, Leon A. , Beemsterboer, Chiel F.P. , Hasnain, Md Golam , Planken, R. Nils , Randen, Adriënne van , Al-Hadethi, Sinan , Hilt, Mirre G.M. , Ruhe, Deborah S.A., Boekholdt, S Matthijs, Chew, Beng Lim Alvin , Fridgant, Joshua, Mena-Romo, Luis , Kim, Dong Hyun, Guo, Shuyu, Winders, Joel, Senadeera, Sajith C. , Lim, Anthony , Fink, John, Leung, Melissa , Cordato, Dennis, Spratt, N., Collaborators, on behalf of the AIS of HEARTS, Green, Daniel S , van Randen, Adrienne , Bouma, Berto J , Boekholdt, S Matthijs , Fridgant, Joshua , Mena-Romo, Luis , Alamri, Yassar , Lim, Anthony T , Leung, Melissa , Cordato, Dennis , Parsons, Mark W , Spratt, Neil J , Garcia-Esperon, Carlos , Wu, Teddy Y , Coutinho, Jonathan M , Beemsterboer, Chiel F P , Planken, R Nils , Berry‐Noronha, Alexander , Hasnain, Md Golam , Hilt, Mirre , Ruhe, Deborah, Bouma, Berto J. , Boekholdt, S. Matthijs , Kim, Dong Hyun, Fink, John
Stroke | June 2, 2026 | Volume: 57 | Issue: 8 | Pages: 2408-2416
BACKGROUND: Cardiac computed tomography (CT) acquired during the acute stroke imaging protocol is an emerging modality to detect cardiac thrombi. We determined its yield in patients with acute ischemic stroke. METHODS: We performed a 1-stage individual patient data meta-analysis of 4 prospective observational cohorts (AIS of HEARTS [Acute Ischemic Stroke of Heart-Related Embolic Sources Detected on Acute Cardiac CT Scans]), including patients with acute ischemic stroke who underwent ECG-gated or non–ECG-gated cardiac CT between May 2018 and June 2024. We excluded patients with transient ischemic attack or stroke mimics. The primary outcome was the proportion of patients with a thrombus on cardiac CT. Secondary outcomes were additional scan time, radiation dose, comparison with echocardiography, and 90-day outcomes. We performed logistic regression analyses to compare 90-day outcomes between patients with and without thrombus, adjusting for age, sex, history of atrial fibrillation, ischemic heart disease, chronic heart failure, stroke or transient ischemic attack, anticoagulant use, prestroke modified Rankin Scale score, National Institutes of Health Stroke Scale score, large vessel occlusions, and intravenous thrombolysis, as appropriate for each outcome. RESULTS: We included 3919 patients (median age, 74 [interquartile range (IQR), 63–82], 58% male, median National Institutes of Health Stroke Scale score 6 [IQR, 3–12]). Cardiac CT detected a thrombus in 243 (6.2%) patients. Among 1323 patients that underwent both cardiac CT and transthoracic echocardiography, cardiac CT had a higher yield than transthoracic echocardiography (odds ratio, 7.4 [95% CI, 4.0–15.1]; P <0.001). Median additional scan time was 6 minutes (IQR, 5–7) for ECG-gated and 13 seconds (IQR, 12–61) for non–ECG-gated cardiac CT. Median additional radiation dose was 2.9 mSv (IQR, 1.6–4.1). Patients with thrombi had higher 90-day mortality (33% versus 15%, adjusted odds ratio, 1.6 [95% CI, 1.1–2.3]) and worse modified Rankin Scale scores (median modified Rankin Scale score 3 versus 2, adjusted odds ratio, 1.6 [95% CI, 1.2–2.0]), but similar recurrent stroke rates (5% versus 4%, adjusted odds ratio, 1.4 [95% CI, 0.7–2.5]). CONCLUSIONS: Implementing cardiac CT into the acute stroke imaging protocol is feasible, detects thrombi in ≈6% of patients, and has a higher yield than transthoracic echocardiography. Cardiac thrombi were associated with higher mortality, but not higher stroke recurrence. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT07165093.
Frequency and management of non-cardiac incidental findings on cardiac CT in patients with a suspected stroke
Beemsterboer, Chiel F P , Nio, Shan Sui , Bj, Bouma, Boekholdt, S Matthijs, Beenen, L. F. M., Marquering, Henk A, Majoie, Charles B L M, Randen, Adriënne van , Planken, R Nils, Rinkel, Leon A, Coutinho, Jonathan M, Marquering, Henk A. , Beemsterboer, Chiel F.P. , Marquering, Henk A , van Randen, Adrienne , Boekholdt, S. Matthijs , Majoie, Charles B.L.M. , Planken, R. Nils , Rinkel, Leon A. , Coutinho, Jonathan M
European Stroke Journal | January 20, 2026 | Volume: 11 | Issue: 1 | Pages: No page available
Abstract Introduction Cardiac CT is increasingly used to screen for cardioembolism in stroke patients. We assessed the frequency and management of non-cardiac incidental findings on prospective ECG-gated cardiac CT in patients with a suspected stroke. Patients and methods This was a post-hoc analysis of the Mind the Heart study, a prospective single-centre cohort study including consecutive adult patients with acute ischaemic stroke (AIS), transient ischaemic attack (TIA), or a stroke mimic who underwent cardiac CT as part of an acute stroke imaging protocol. Endpoints were pre-defined non-cardiac incidental findings that were detected on cardiac CT: pulmonary embolism (PE), potential malignant lesions, pulmonary consolidations or ground-glass densities, bone fractures, lymphadenopathy, focal liver lesions, and ascending aortic or pulmonary artery dilatation. Change of management was defined as additional treatment or follow-up. Results We included 654 patients (57% men, median age 71 [IQR 59–80] years) of whom 451 (69%) had AIS, 48 had TIA (7%), and 155 had a stroke mimic (24%). Overall, 58 non-cardiac incidental findings were found in 55 (8%; 95%CI, 6–11) patients. The most frequent incidental findings were consolidations or ground-glass densities (n = 17, 3%), liver cysts or non-specific hypodensities (n = 14, 2%), pulmonary nodules or masses (n = 9, 1%), and PEs (n = 8, 1%). Incidental findings led to a change of management in 17/55 (31%) patients of whom 13/55 (24%) had additional follow-up and 9/55 (16%) received treatment (anticoagulation n = 8, chemotherapy n = 1). Discussion & Conclusion Non-cardiac incidental findings were observed on cardiac CT in 8% of patients with a suspected stroke. These findings changed management in 31% of these patients.