Garcia-Esperon Carlos, Berry-Noronha Alexander, Di Bartolo Angelo, Green Daniel S, Hasnain Md Golam, Sharma Gagan Jyoti, Coutinho Jonathan M, Planken R Nils, Rinkel Leon A, Nio Shan Sui, Lim Anthony, Kim Jamin, Chew Beng Lim Alvin, Leung Melissa, Al-Hadethi Sinan, Lin Longting, Levi Christopher R, Spratt Neil James, Wu Teddy, Parsons Mark W
Department of Neurology, John Hunter Hospital, Newcastle, Australia.
Faculty of Medicine, University of Newcastle, Australia.
Neurology. 2025 Feb 11;104(3):e210256. doi: 10.1212/WNL.0000000000210256. Epub 2025 Jan 13.
Hyperacute cardiac CT has shown greater yield for intracardiac thrombus identification compared with transthoracic echocardiography. However, routine use comes with higher cost and additional contrast and radiation exposure. Pretest identification of patients with low probability of thrombus would enable rationalization of its use. Arterial input function (AIF) curves are generated automatically as part of brain perfusion CT. Time from scan onset to the end of AIF (AIF dispersal) is correlated with left ventricular ejection fraction. We hypothesized that there would be an association between AIF dispersal and (1) presence of intracardiac thrombus and (2) 3-month outcome after ischemic stroke/TIA.
This is a retrospective analysis of prospectively collected patients with a final diagnosis of ischemic stroke or TIA presenting at 3 comprehensive stroke centers between September 2019 and August 2023.
A total of 1,136 patients were included, and the median age was 74 years (interquartile range, IQR [62-81]). The median baseline National Institutes of Health Stroke Scale score was 6 (IQR [3-14]). Intracardiac thrombus was present in 59 patients (5.2%) on hyperacute cardiac CT. The median AIF dispersal was 27 (IQR [22-33]) seconds. Longer AIF dispersal duration was associated with presence of intracardiac thrombus, with an odds ratio (OR) of 1.09 (95% CI 1.05-1.13). AIF dispersal ≥33 seconds was the optimal cutoff point for presence of intracardiac thrombus with a positive association, with OR 6.66 (3.26-13.59). AIF dispersal as a continuous variable was associated with increased risk of poor outcome (modified Rankin Scale scores 5-6) 3 months after stroke in multivariate analysis (OR 1.03 [95% CI 1.00-1.05]). AIF dispersal ≥33 seconds was also associated with worse outcome after stroke in univariate analysis.
Prolonged AIF dispersal identifies patients with stroke more likely to have (1) an intracardiac thrombus at the time of presentation and (2) poor outcome 3 months after stroke. These novel findings have significant clinical implications.
与经胸超声心动图相比，超急性心脏CT在识别心内血栓方面具有更高的检出率。然而，常规使用成本更高，且会增加造影剂和辐射暴露。对血栓形成可能性较低的患者进行预测试，有助于合理使用该检查。动脉输入函数（AIF）曲线是脑灌注CT自动生成的一部分。从扫描开始到AIF结束的时间（AIF离散度）与左心室射血分数相关。我们假设AIF离散度与（1）心内血栓的存在以及（2）缺血性卒中/TIA后3个月的预后之间存在关联。
这是一项对2019年9月至2023年8月期间在3个综合卒中中心就诊、最终诊断为缺血性卒中和TIA的患者进行的前瞻性收集数据的回顾性分析。
共纳入1136例患者，中位年龄为74岁（四分位间距，IQR[62 - 81]）。基线美国国立卫生研究院卒中量表评分的中位数为6（IQR[3 - 14]）。超急性心脏CT显示59例患者（5.2%）存在心内血栓。AIF离散度的中位数为27秒（IQR[22 - 33]）。AIF离散持续时间延长与心内血栓的存在相关，比值比（OR）为1.09（95%CI 1.05 - 1.13）。AIF离散度≥33秒是心内血栓存在的最佳截断点，呈正相关，OR为6.66（3.26 - 13.59）。在多变量分析中，AIF离散度作为连续变量与卒中后3个月不良预后（改良Rankin量表评分5 - 6）风险增加相关（OR 1.03[95%CI 1.00 - 1.05]）。在单变量分析中，AIF离散度≥33秒也与卒中后更差的预后相关。
AIF离散度延长可识别出更有可能在就诊时（1）存在心内血栓以及在卒中后3个月（2）预后不良的卒中患者。这些新发现具有重要的临床意义。
