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Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients

 Jin Hur  ;  Young Jin Kim  ;  Hye-Jeong Lee  ;  Jong-Won Ha  ;  Ji Hoe Heo  ;  Eui-Young Choi  ;  Chi-Young Shim  ;  Tae Hoon Kim  ;  Ji Eun Nam  ;  Kyu Ok Choe  ;  Byoung Wook Choi 
 STROKE, Vol.40(6) : 2073-2078, 2009 
Journal Title
Issue Date
Adrenergic beta-Antagonists ; Aged ; Coronary Thrombosis/complications* ; Coronary Thrombosis/diagnostic imaging* ; Echocardiography, Transesophageal ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Predictive Value of Tests ; Propranolol ; Prospective Studies ; Risk Assessment ; Stroke/diagnostic imaging* ; Stroke/etiology* ; Tomography, X-Ray Computed
BACKGROUND AND PURPOSE: We assessed the diagnostic performance of 2-phase 64-slice cardiac computed tomographic angiography (CCTA) for the detection of a cardiac source of embolism in stroke patients using transesophageal echocardiography (TEE) as the reference standard. METHODS: We selected 137 patients who had experienced a recent episode of stroke and had undergone both 2-phase 64-slice CCTA and TEE within a period of 5 days. A potential cardiac source of embolism detected at both CCTA and TEE was recorded, and echocardiographic findings were categorized into high- and medium-risk sources based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. RESULTS: Of 137 patients, 100 abnormal findings in 91 patients were found on TEE, and 46 patients had no abnormal finding on TEE. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the 64-slice CCTA for detecting cardiac sources of embolism were 89% (95% CI, 82%, 95%), 100% (95% CI, 90%, 100%), 100% (95% CI, 95%, 100%), and 81% (95% CI, 70%, 92%), respectively. TEE detected a total of 47 high-risk sources of embolism, whereas CT detected 44 lesions. For medium-risk sources of cardiac embolic stroke, TEE detected a total of 53 abnormal findings, whereas CT detected 44 abnormal findings. Of 53 lesions, there were 8 false-negative results on CT (5 patent foramen ovale and 3 atrial septal aneurysm). CONCLUSIONS: Two-phase 64-slice CCTA is a noninvasive and useful modality for detecting high-risk cardiac sources of embolism in stroke patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Kim, Tae Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-3598-2529
Nam, Ji Eun(남지은)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Choe, Kyu Ok(최규옥)
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
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