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Predictors of Recurrent Stroke in Patients with Ischemic Stroke: Comparison Study between Transesophageal Echocardiography and Cardiac CT

 Kyeho Lee  ;  Jin Hur  ;  Sae Rom Hong  ;  Young Joo Suh  ;  Dong Jin Im  ;  Yun Jung Kim  ;  Yoo Jin Hong  ;  Hye-Jeong Lee  ;  Young Jin Kim  ;  Hye Sun Lee  ;  Geu-Ru Hong  ;  Byoung Wook Choi 
 RADIOLOGY, Vol.276(2) : 381-389, 2015 
Journal Title
Issue Date
Aged ; Brain Ischemia/complications ; Brain Ischemia/diagnosis* ; Brain Ischemia/epidemiology* ; Cardiac Imaging Techniques* ; Echocardiography, Transesophageal* ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Recurrence ; Risk Assessment ; Stroke/diagnosis* ; Stroke/epidemiology* ; Stroke/etiology ; Tomography, X-Ray Computed*
PURPOSE: To investigate cardiac computed tomographic (CT) findings predictive of recurrent stroke in patients with ischemic stroke and determine the incremental risk stratification benefit of cardiac CT findings compared with transesophageal echocardiography (TEE) findings in patients with ischemic stroke.
MATERIALS AND METHODS: This single-center prospective study protocol was approved by the institutional review boards, and written informed consent was obtained from all patients. Among 548 consecutive patients, 374 patients with ischemic stroke (254 men and 120 women, with a mean age of 63.1 years) who underwent TEE and cardiac CT were prospectively enrolled in this study. TEE and cardiac CT images were assessed for cardioembolic sources, including thrombus, tumor, spontaneous echo contrast, valvular vegetation, atrial septal aneurysm, patent foramen ovale, and aortic plaque. The primary end point was stroke recurrence. Prognostic factors were assessed with Cox univariate and multivariate analysis. The integrated area under the receiver operating characteristic curve was calculated to compare the prognostic abilities of CT and TEE parameters.
RESULTS: During a median follow-up period of 433 days, there were a total of 28 recurrent stroke events. The TEE parameter of plaque complexity (hazard ratio, 13.512; 95% confidence interval: 3.668, 49.778; P < .001) and CT parameter of plaque complexity (hazard ratio, 32.538; 95% confidence interval: 7.544, 140.347; P < .001) were predictors of recurrent stroke. The time-dependent receiver operating characteristic curve analysis demonstrated no significant differences in prediction of recurrent stroke between TEE and CT parameters (integrated area under the receiver operating characteristic curve, 0.812 vs 0.840, respectively).
CONCLUSION: Complex aortic plaque evaluated with cardiac CT and TEE was associated with an increased risk of stroke recurrence in patients with ischemic stroke.
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Appears in Collections:
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) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Kim, Yun Jung(김윤정)
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
Lee, Kye Ho(이계호) ORCID logo https://orcid.org/0000-0001-5568-1833
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Im, Dong Jin(임동진) ORCID logo https://orcid.org/0000-0001-8139-5646
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
Hong, Sae Rom(홍새롬)
Hong, Yoo Jin(홍유진) ORCID logo https://orcid.org/0000-0002-7276-0944
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