scholarly journals Cardiovascular MRI Compared to Echocardiography to Identify Cardioaortic Sources of Ischemic Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas R. Meinel ◽  
Angela Eggimann ◽  
Kristina Brignoli ◽  
Kerstin Wustmann ◽  
Eric Buffle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Diagnostic Yield ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Foramen Ovale ◽  
Cardiovascular Mri ◽  
Ventricular Thrombus ◽  
Persistent Foramen Ovale ◽  
The Impact

Background: To compare the diagnostic yield of echocardiography and cardiovascular MRI (CMR) to detect structural sources of embolism, in patients with ischemic stroke with a secondary analysis of non-stroke populations.Methods and Results: We searched MEDLINE/Embase (from 01.01.2000 to 24.04.2021) for studies including CMR to assess prespecified sources of embolism. Comparison included transthoracic and/or transesophageal echocardiography. Two authors independently screened studies, extracted data and assessed bias using the QUADAS-2 tool. Estimates of diagnostic yield were reported and pooled. Twenty-seven studies with 2,525 patients were included in a study-level analysis. Most studies had moderate to high risk of bias. Persistent foramen ovale, complex aortic plaques, left ventricular and left atrial thrombus were the most common pathologies. There was no difference in the yield of left ventricular thrombus detection between both modalities for stroke populations (4 studies), but an increased yield of CMR in non-stroke populations (28.1 vs. 16.0%, P < 0.001, 10 studies). The diagnostic yield in stroke patients for detection of persistent foramen ovale was lower in CMR compared to transoesophageal echocardiography (29.3 vs. 53.7%, P < 0.001, 5 studies). For both echocardiography and CMR the clinical impact of the management consequences derived from many of the diagnostic findings remained undetermined in the identified studies.Conclusions: Echocardiography and CMR seem to have similar diagnostic yield for most cardioaortic sources of embolism except persistent foramen ovale and left ventricular thrombus. Randomized controlled diagnostic trials are necessary to understand the impact on the management and potential clinical benefits of the assessment of structural cardioaortic stroke sources.Registration: PROSPERO: CRD42020158787.

scholarly journals Dabigatran Effect on Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke

2015 ◽  
Vol 17 (3) ◽  
pp. 366-368 ◽  
Author(s):  
Kyuyoon Chung ◽  
Young Min Paek ◽  
Hye Jung Lee ◽  
Keun-Sik Hong
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus

scholarly journals Direct oral anticoagulant use in left ventricular thrombus

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zafar Ali ◽  
Nicholas Isom ◽  
Tarun Dalia ◽  
Farhad Sami ◽  
Uzair Mahmood ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ischemic Cardiomyopathy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Significant Risk ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus ◽  
Peripheral Embolization ◽  
One Year

Abstract Left ventricular thrombus (LVT) is associated with a significant risk of ischemic stroke (IS) and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. We studied the natural history of LVT with anticoagulation (AC) with emphasis on comparing warfarin and DOAC use. In this single center study, we identified patients with a confirmed LVT. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, and thrombus resolution) were recorded. LVT was confirmed in a total of 110 patients. Mean age was 59 + 14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients. At 1 year follow up, 11 patients (10%) had a stroke while on any AC (2 had hemorrhagic stroke and 9 had IS). Of those with IS, 7 were on warfarin (71% of those had subtherapeutic INR) and 2 patients on DOACs had IS. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group (p = 0.33). 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus (p = 0.85). One-year risk of stroke with LVT is high (10%) even with AC. Most patients IS on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.

Abstract 15803: Effectiveness of Direct Oral Anticoagulant versus Warfarin in the Treatment of Left Ventricular Thrombus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas Isom ◽  
Zafar Ali ◽  
Tarun Dalia ◽  
Farhad Sami ◽  
Uzair Mahmood ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Ischemic Cardiomyopathy ◽  
Academic Medical Center ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus ◽  
Peripheral Embolization ◽  
One Year

Introduction: Left ventricular thrombus (LVT) is associated with a higher risk of ischemic stroke and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. Data on natural history and thrombus resolution with anticoagulation (AC), especially with DOACs is scarce. We studied the natural history of LVT with AC with emphasis on comparing warfarin and DOACs use. Methods: This is a single center, retrospective study conducted in an academic medical center. We identified patients (echocardiogram, CT or MRI) with a confirmed LVT study who were followed at our center. Chart review was conducted to collect clinical information at presentation and on follow up. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, mortality) were recorded. Thrombus resolution on follow up imaging was also recorded. Results: LVT was confirmed in a total of 110 patients. Mean age was 59±14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients (in remaining patients AC was thought to be contraindicated). Of those on long-term AC, 60 patients (63%) were treated with warfarin, 3 patients (3%) with enoxaparin and 32 patients (33%) with a DOACs. At one year follow up, 11 patients (10%) had a stroke while on any AC. Two of these patients had hemorrhagic stroke (both on warfarin) and 9 patients had ischemic stroke. Of those with ischemic stroke 7 were on warfarin and 2 patients on DOACs had ischemic strokes. Of those with ischemic stroke on warfarin, 71% had subtherapeutic INR. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group (p= 0.33). Total of 55 (57%) of patient started on AC had resolution of thrombus. 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus (p= 0.85). Conclusions: One year risk of stroke with LVT is high (10%) even with AC. Most patients with ischemic stroke on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.

scholarly journals Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Fan Ye ◽  
Burton V. Silverstein ◽  
Matheen A. Khuddus ◽  
Christopher L. Bray ◽  
Arthur C. Lee
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Dual Antiplatelet Therapy ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Interesting Case ◽  
Left Ventricular Thrombus ◽  
Significant Past Medical History ◽  
Ventricular Thrombus

A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.

scholarly journals Acute Ischemic Stroke in a Young Patient with Left Ventricular Thrombus Attributed to Doxorubicin Cardiomyopathy

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 178-182
Author(s):  
Eung-Joon Lee ◽  
Byung-Woo Yoon
Keyword(s):  
Adverse Effect ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Young Patient ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Contractility ◽  
Ventricular Thrombus ◽  
Cardiomyopathy Patient ◽  
Doxorubicin Cardiomyopathy

We report a case of acute middle cerebral territory ischemic infarction caused by left ventricular thrombus (LVT) in a doxorubicin cardiomyopathy patient. A major adverse effect of doxorubicin is cardiotoxicity. In doxorubicin cardiomyopathy, as the ventricular contractility decreases, LVT can occur and lead to systemic embolic events such as stroke.

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