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PURPOSE: Risk stratification for incidence of major adverse cardiovascular events (MACE) in patients with dialysis-dependent end-stage renal disease (dd-ESRD) is challenging. Moreover, the usefulness of coronary CT angiography (CCTA) is often limited because of high calcification. This study aimed to investigate the prognostic value of comprehensive cardiac CT in patients with dd-ESRD for predicting MACE. MATERIALS AND METHODS: This retrospective analysis included 92 patients with dd-ESRD who underwent comprehensive cardiac CT. Obstructive coronary artery disease (CAD) was defined by CCTA with > 50% stenosis. Global myocardial blood flow (MBF) and summed stress score (SSS) were obtained through dynamic CTP. Cox regression analysis was used to assess correlation with MACE. Kaplan-Meier curves were used to estimate cumulative event rates, and the global Chi-square test was used to assess the incremental value of dynamic CTP over CCTA. RESULTS: During a median follow-up of 2.3 years, 43 patients experienced MACE. Univariate analysis revealed that presence of obstructive CAD, higher SSS, and lower global MBF were significantly associated with increased risk of MACE. In multivariable analysis, lower global MBF and presence of obstructive CAD were independently associated with MACE (p = 0.02, and p = 0.04, respectively). CCTA and dynamic CTP combination had incremental value over CCTA alone for predicting MACE, respectively (global Chi-square score, 19.3 and 11.7, respectively). CONCLUSION: Presence of obstructive CAD on CCTA and lower global MBF on dynamic CTP are independently associated with increased risk of MACE in patients with dd-ESRD. The addition of dynamic CTP to CCTA may improve risk stratification in this population.
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Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare condition; late adult presentation is extremely rare but, with modern diagnostics, more asymptomatic or mildly symptomatic elderly patients with ALCAPA are found. A 76-year-old woman was admitted to our emergency department in December 2021 with fever, fatigue, cognitive-motor slowing, and hyposthenia of left hemisoma. Cranium computed tomography (CT) was performed, with no signs of stroke. Contrast-enhanced CT, performed with electrocardiogram-gated technique, showed a dilatated left coronary artery arising directly from the main pulmonary artery; right coronary artery was markedly dilated and tortuous and characterized by multiple inter-coronary collateral arteries with left coronary artery, in particular in the retro-aortic side and along the cone artery. ALCAPA syndrome represents one of the most common causes of myocardial ischemia in children and, if left untreated, results in a mortality rate of up to 80-90â¯% within the first year of life. In our case, no previous history of cardiological disease was found that could have suggested this type of condition. This is extremely rare, especially if we consider that our patient reached the 8th decade of life. Learning objectives: â¢ALCAPA syndrome can present in adulthood.â¢Collaterals between coronary arteries are essential to guarantee the survival into adulthood.â¢Cardiac computed tomography imaging is essential for the diagnosis.
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In the evaluation of cardiomyopathies, cardiac computed tomography (CCT) is predominantly used for assessing congenital or acquired coronary artery diseases as a potential etiology underlying the observed myocardial abnormalities. However, its utility is expected to expand. We present a case of an asymptomatic patient with claustrophobia who sought medical attention due to frequent ventricular beats. The resting electrocardiogram revealed repolarization abnormalities characterized by flattened T-waves in the lateral leads and low QRS voltages in the peripheral leads, whereas transthoracic echocardiography was normal. CCT accurately identified hypodense areas indicative of fibrofatty infiltration within the inferolateral and anterior walls of the left ventricle. Furthermore, late iodine contrast-phase imaging revealed subepicardial late enhancement striae in the same regions. These imaging findings were pivotal in establishing a diagnosis of left-dominant arrhythmogenic cardiomyopathy. This clinical vignette underscores the potential of CCT in tissue characterization, particularly when cardiac magnetic resonance imaging is contraindicated or unavailable.
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AIMS: To evaluate the consistency between fractal dimensions (FD) derived from cardiac computed tomography (CT-FD) and cardiac magnetic resonance (MR-FD) in assessing left ventricular trabecular complexity. METHODS: This retrospective study included 170 patients who underwent CCT and CMR scans within two weeks. Five short-axis cine images were selected at end-diastole: one basal, three mid, and one apical slice. Short-axis CCT views were reconstructed and aligned with the cine images. CT-FD and MR-FD values were calculated for each slice, with mean values determined for each patient. Severe left ventricular hypertrophy (LVH) was defined as a maximum wall thickness > 15 mm in end-diastolic cine images. RESULTS: The diastolic CT-FD and MR-FD values exhibited high consistency, with values of 1.253 ± 0.091 and 1.250 ± 0.102, respectively (n = 535, ICC = 0.882, 95 % CI: 0.861-0.899, P < 0.001). Similarly, the systolic CT-FD and MR-FD values demonstrated good consistency, with values of 1.268 ± 0.072 and 1.286 ± 0.093, respectively (n = 390, ICC = 0.720, 95 % CI: 0.669-0.765, P < 0.001). For subgroups of systolic NLVH and LVH, the ICCs were 0.773 (n = 305, CI: 0.723-0.814, P < 0.001) and 0.565 (n = 85, 95 % CI: 0.402-0.694, P < 0.001), respectively. The diagnostic efficacy of mean CT-FD aligned with that of mean MR-FD in distinguishing abnormal cardiac conditions from the CMR-negative group. CONCLUSIONS: CCT is a feasible method for assessing left ventricular trabecular complexity, with good agreement with CMR, except in cases of severe left ventricular hypertrophy during systole.
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Approximately 5% of elderly patients suffer from moderate or severe tricuspid valve regurgitation, which is an independent predictor of high morbidity and mortality. Surgical treatment of isolated tricuspid valve regurgitation has been associated with elevated fatality rate, leading to a growing interest in minimal invasive, transcatheter-based therapies such as transcatheter edge-to-edge repair and transcatheter valve replacement. Nevertheless, despite high procedural efficacy and safety of transcatheter-based therapies, a number of challenges limit their rapid adoption in routine clinical practice. In particular, the wide range of transcatheter approaches to address the significant variability in tricuspid valve pathology challenges the reproducibility of clinical outcomes. Multimodality imaging is pivotal for grading the regurgitation severity, determining the underlying pathology, assessing RV function and pulmonary pressures, identifying concomitant cardiac disease, and selecting the most beneficial treatment modality and access. This article reviews the role of different imaging modalities in guiding the management of patients with significant tricuspid valve regurgitation.
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Imagem Multimodal , Insuficiência da Valva Tricúspide , Humanos , Insuficiência da Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Imagem Multimodal/métodos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Ecocardiografia/métodos , Implante de Prótese de Valva Cardíaca/métodosRESUMO
BACKGROUND: Prospective ECG-triggered cardiac computed tomography (CT) imaging limits the ability to assess left ventricular (LV) ejection fraction (EF). We previously developed a new index derived from LV volume changes over 100 âms during systole (LVEF100msec) as a surrogate of LV function in patients undergoing prospective ECG-triggered cardiac CT. We sought to evaluate the prognostic value of LVEF100msec. METHODS: Patients undergoing prospective systolic ECG-triggered cardiac CT were enrolled between January 2015 and September 2022. Each CT was analyzed for LVEF100msec. Area under the curve analysis and Cox proportional hazards models were used to define the best LVEF100msec cut-off and to predict major adverse cardiovascular events (MACE), defined as a composite of all-cause death, cardiac death/arrest, non-fatal myocardial infarction, and stroke. RESULTS: The study enrolled 313 patients (median age â= â58 years, male â= â52.4 â%). During a median follow-up of 924 (660-1365) days, 24 (7.7 â%) patients had MACE. LVEF100msec was significantly lower in the MACE group compared to the non-MACE group (4.8 â% vs. 8.3 â%, p â= â0.002). Optimal LVEF100msec cut-off for predicting MACE was 6.3 â%. MACE-free survival rate was significantly lower in patients with LVEF100msec ≤6.3 â% than those with >6.3 â% (p â< â0.001). LVEF100msec ≤6.3 â% was an independent predictor of MACE, with an adjusted hazard ratio of 3.758 (95 â% CI, 1.543-9.148; p â= â0.004). The prognostic value of LVEF100msec was consistent across the various severities of coronary artery disease. CONCLUSION: LVEF100msec was an independent predictor of adverse events. The implementation of LVEF100msec may improve the prognostic value of prospective ECG-triggered cardiac CT.
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INTRODUCTION: Guidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration. METHODS: We implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200-400 âms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 â= ânon-interpretable; 2 â= âpoor; 3 â= âacceptable; 4 â= âgood; 5 â= âexcellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans. RESULTS: Post-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75-125) min vs. phase 1: 68 (52-88) min and phase 2: 72 (59-90) min; P â< â0.001] and scan times [phase 0: 13 (10-16) min vs. phase 1: 8 (6-13) min and phase 2: 9 (7-13) min; P â< â0.001]. Median IQ score in both post-process change phases was 4 (4-5) compared to a median score of 5 (4-5) pre-process change (P for comparison <0.001). The majority of segments post-process change had "good" IQ (Phase 1 segmental IQ scores: 5 â= â36.7 â%, 4 â= â46.8 â%, 3 â= â13 â%, 2 â= â2.6 â%, 1 â= â0.9 â%; Phase 2 segmental IQ scores: 5 â= â26 â%, 4 â= â49.7 â%, 3 â= â16.3 â%, 2 â= â6.1 â%, 1 â= â1.9 â%), whereas pre-process change, the majority of segments had "excellent" IQ (Phase 0 segmental IQ scores: 5 â= â56 â%, 4 â= â34.3 â%, 3 â= â7.5 â%, 2 â= â1.8 â%, 1 â= â0.4 â%) There was no significant increase in non-interpretable scans at the patient level. The 22 â% re-scan rate in phase 1 (vs. 6 â% in phase 0, P â= â.002) improved to 15 â% in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 â% CI 1.12-6.51, P â= â0.03; aOR morbidly obese 6.94, 95 â% CI 2.21-23.52, P â= â0.001] and average HR [aOR (per 10 bpm increase) 1.51, 95 â% CI 1.21-1.9, P â< â0.001] were associated with the scoring of any segment as â≤ â3 âat the patient level in a fully adjusted model, the improved phase 2 of the process change was not [aOR 1.61, 95 â% CI 0.78-3.32]. CONCLUSION: Implementation of an institutional process change utilizing prospective ECG-triggered dual-source end-systolic acquisition avoided the use of beta-blockers, significantly reduced patient appointment and scan times with acceptable diagnostic performance.
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We present a case of cardioembolic stroke in a patient with a history of mechanical aortic valve who was compliant with anticoagulation medication. Cardiac computed tomography was used as an alternative, noninvasive means of evaluation for the cardioembolic source of stroke and identified subvalvular mobile pannus of the mechanical aortic valve.
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A 19-year-old man survived sudden cardiac arrest caused by ventricular fibrillation during physical activity. The initial suspicion that this was caused by electrolyte imbalance proved to be wrong. Cardiac computed tomography revealed congenital heart disease. Coronary imaging is an essential component of the comprehensive diagnostic workup after sudden cardiac arrest.
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BACKGROUND: Quantifying myocardial extracellular volume (ECV) using computed tomography (CT) has been shown to be useful in the evaluation of cardiac amyloidosis. However, the reproducibility of CT measurements for myocardial ECV, is not well-established in patients with proven cardiac amyloidosis. METHODS: This prospective single-center study enrolled cardiac amyloidosis patients to undergo dual-energy CT for myocardial fibrosis assessment. Delayed imaging at 7 and 8 âmin post-contrast and independent evaluations by two blinded cardiologists were performed for ECV quantification using 16-segment (ECVglobal) and septal sampling (ECVseptal). Inter- and intraobserver variability and test-retest reliability were measured using Spearman's rank correlation, Bland-Altman analysis, and intraclass correlation coefficients (ICC). RESULTS: Among the 24 participants (median age â= â78, 67 â% male), CT ECVglobal and ECVseptal showed median values of 53.6 â% and 49.1 â% at 7 âmin, and 53.3 â% and 50.1 â% at 8 âmin, respectively. Inter- and intraobserver variability and test-retest reliability for CT ECVglobal (ICC â= â0.798, 0.912, and 0.894, respectively) and ECVseptal (ICC â= â0.791, 0.898, and 0.852, respectively) indicated good reproducibility, with no evidence of systemic bias between observers or scans. CONCLUSIONS: Dual-energy CT-derived ECV measurements demonstrated good reproducibility in patients with proven cardiac amyloidosis, suggesting potential utility as a repeatable imaging biomarker for this disease.
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Transvenous lead extraction is performed for device infection, lead failure, or to provide access for additional leads/device upgrade. A patient-centered risk assessment for transvenous lead extraction can be determined using a combination of clinical factors and several imaging modalities. Predicting a complex lead extraction, for example, one that will require powered tools or the use of a femoral approach, is aided by pre-procedural imaging and clinical assessment. Procedural imaging utilizing fluoroscopy, transesophageal echocardiography, and intracardiac echocardiography during an extraction can improve safety and identify complications rapidly.
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Desfibriladores Implantáveis , Remoção de Dispositivo , Marca-Passo Artificial , Humanos , Remoção de Dispositivo/métodos , Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Cuidados Pré-Operatórios/métodos , Fluoroscopia , Ecocardiografia TransesofagianaRESUMO
BACKGROUND: We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy. METHODS: This retrospective study included 65 patients with CP (mean age: 58.9 â± â8.0 years) and 65 healthy individuals (mean age: 58.0 â± â6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis. RESULTS: Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 â% vs. 27.4 â%), right atrium (RA) reservoir strain (15.1 â% vs. 27.0 â%), left ventricle (LV) global longitudinal strain (GLS) (-17.0 â% vs. -19.5 â%), and right ventricle free wall longitudinal strain (-21.1 â% vs. -25.9 â%) (all p â< â0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 â% confidence interval, 0.86-0.96- p â= â0.001) was an independent prognostic factor for adverse events in patients with CP. CONCLUSION: Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.
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Cardiovascular disease (CVD) is the leading cause of death worldwide. Coronary artery disease (CAD), a prevalent form of CVD, is typically assessed using catheter coronary angiography (CCA), an invasive, costly procedure with associated risks. While cardiac computed tomography angiography (CTA) presents a less invasive alternative, it suffers from limited temporal resolution, often resulting in motion artifacts that degrade diagnostic quality. Traditional ECG-based gating methods for CTA inadequately capture cardiac mechanical motion. To address this, we propose a novel multimodal approach that enhances CTA imaging by predicting cardiac quiescent periods using seismocardiogram (SCG) and ECG data, integrated through a weighted fusion (WF) approach and artificial neural networks (ANNs). We developed a regression-based ANN framework (r-ANN WF) designed to improve prediction accuracy and reduce computational complexity, which was compared with a classification-based framework (c-ANN WF), ECG gating, and US data. Our results demonstrate that the r-ANN WF approach improved overall diastolic and systolic cardiac quiescence prediction accuracy by 52.6% compared to ECG-based predictions, using ultrasound (US) as the ground truth, with an average prediction time of 4.83 ms. Comparative evaluations based on reconstructed CTA images show that both r-ANN WF and c-ANN WF offer diagnostic quality comparable to US-based gating, underscoring their clinical potential. Additionally, the lower computational complexity of r-ANN WF makes it suitable for real-time applications. This approach could enhance CTA's diagnostic quality, offering a more accurate and efficient method for CVD diagnosis and management.
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Background: Coronary computed tomography angiography (CCTA) has emerged as a reliable noninvasive modality to assess coronary artery stenosis and high-risk plaque (HRP). However, CCTA assessment of stenosis and HRP is time-consuming and requires specialized training, limiting its clinical translation. Objectives: The aim of this study is to develop and validate a fully automated deep learning system capable of characterizing stenosis severity and HRP on CCTA. Methods: A deep learning system was trained to assess stenosis and HRP on CCTA scans from 570 patients in multiple centers. Stenosis severity was categorized as >0%, 1 to 49%, ≥50%, and ≥70%. HRP was defined as low attenuation plaque (≤30 HU), positive remodeling (≥10% diameter), and spotty calcification (<3 mm). The model was then tested on 769 patients (3,012 vessels) for stenosis severity and 45 patients (325 vessels) for HRP. Results: Our deep learning system achieved 93.5% per-vessel agreement within 1 Coronary Artery Disease-Reporting and Data System (CAD-RADS) category for stenosis. Diagnostic performance for per-vessel stenosis was very good for sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve with: >0% stenosis: 90.6%, 88.8%, 83.4%, 93.9%, 89.7%, respectively; ≥50% stenosis: 87.1%, 92.3%, 60.9%, 98.1%, 89.7%, respectively. Similarly, the per-vessel HRP feature achieved very good diagnostic performance with an area under the curve of 0.80, 0.79, and 0.77 for low attenuation plaque, spotty calcification, and positive remodeling, respectively. Conclusions: A fully automated unsupervised deep learning system can rapidly evaluate stenosis severity and characterize HRP with very good diagnostic performance on CCTA.
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Background: Despite the essential role of ectopic osteogenic calcium-phosphate metabolism in the development of calcific aortic valve disease (CAVD), the implications of high serum phosphate levels in CAVD development are not fully understood. Methods: Asymptomatic individuals who underwent health screening using serial cardiac computed tomography (CT) and echocardiography were selected from a multicenter registry. CAVD was identified and quantified on CT images using the aortic valve calcification (AVC) score. The associations between initial serum phosphate levels and the presence of baseline CAVD, development of new CAVD, and the AVC score progression rate were investigated using multivariable regression models. Results: A total of 736 individuals were selected for analysis, and the median interscan duration was 36.4 months. On initial CT, 83 (13.7%) participants had baseline CAVD, while 52 (7.0%) individuals developed new CAVD during follow-up. Serum phosphate levels were not associated with a higher probability of baseline CAVD but were predictive of newly developed CAVD (odds ratio per 1â mg/dl, 1.05; 95% confidence interval, 1.01-1.10; p = 0.02). Higher phosphate levels were also associated with a faster AVC score progression in those with baseline CAVD (regression coefficient per 1â mg/dl, 15.55 Agatston units/year; 95% confidence interval, 6.02-25.07; p < 0.01), an association which remained significant when the analysis was extended to include newly developed CAVD. Conclusion: Even slight elevations in serum phosphate are associated with accelerated CAVD progression from an early stage. Further studies are needed to investigate whether the regulation of phosphate metabolism can slow the progression of CAVD to aortic stenosis.
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PURPOSE OF THE REVIEW: The purpose of this review is to evaluate the current state of knowledge regarding the technical challenges associated with the Post-Acquisition Fat Attenuation Index (PFAI). By examining the limitations and gaps in the current methodologies, this review aims to provide a comprehensive understanding of how various factors impact the accuracy and reliability of PFAI measurements. RECENT FINDINGS: PFAI correlates with plaque instability, as inflammation in coronary plaque alters surrounding adipose tissue composition, increasing its water content and reducing lipid content, which is detectable via cardiac CT as increased attenuation. Recent studies have demonstrated PFA's prognostic value, with elevated levels linked to higher risks of cardiac events and plaque instability. A 2022 meta-analysis confirmed its association with major adverse cardiac events. Machine learning algorithms incorporating PFA and additional imaging features have further enhanced risk prediction beyond traditional metrics. Pericoronary fat attenuation is a promising marker for assessing coronary inflammation and could be useful in predicting plaque development, rupture, and monitoring treatment response, though further prospective studies and technical standardization are needed to fully establish its clinical benefits.
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Tecido Adiposo , Doença da Artéria Coronariana , Placa Aterosclerótica , Humanos , Tecido Adiposo/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Prognóstico , Vasos Coronários/diagnóstico por imagem , Reprodutibilidade dos Testes , Tecido Adiposo EpicárdicoRESUMO
Infective Endocarditis (IE) remains a significant health challenge. Despite an increasing awareness, mortality is high and has remained largely unchanged over recent decades. Early diagnosis of IE is imperative and to assist clinicians several diagnostic criteria have been proposed. The best known are the Duke criteria. Originally published in 1994, these criteria have undergone significant modifications. This manuscript provides a timeline of the successive changes that have been made over the last 30 years. Changes which to a large degree have reflected both the evolving epidemiology of IE and the proliferation and increasing availability of advanced multi-modality imaging. Importantly, many of these changes now form part of societal guidelines for the diagnosis of IE. To provide validation for the incorporation of cardiac computed tomography (CT) in current guidelines, the manuscript demonstrates a spectrum of pictorial case studies that re-enforce the utility and growing importance of early cardiac CT in the diagnosis and treatment of suspected IE.
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Transesophageal echocardiography (TEE) is the standard method for diagnosing left atrial appendage (LAA) hypercoagulability in patients with atrial fibrillation (AF), which means LAA thrombus/sludge, dense spontaneous echo contrast and slow LAA blood flow velocity (< 0.25 m/s). Based on machine learning algorithms, cardiac computed tomography angiography (CCTA) radiomics features were adopted to construct prediction models and explore a suitable approach for diagnosing LAA hypercoagulability and adjusting anticoagulation. This study included 652 patients with non-valvular AF. The univariate analysis were used to select meaningful clinical characteristics to predict LAA hypercoagulability. Then 3D Slicer software was adopted to extract radiomics features from CCTA imaging. The radiomics score was calculated using the least absolute shrinkage and selection operator logistic regression analysis to predict LAA hypercoagulability. We then combined clinical characteristics and radiomics scores to construct a nomogram model. Finally, we got prediction models based on machine learning algorithms and logistic regression separately. The area under the receiver operating characteristic curve of radiomics score was 0.8449 in the training set and 0.7998 in the validation set. The nomogram model had a concordance index of 0.838. The final machine-learning based prediction models had good performances (best f1 score = 0.85). Radiomics features of long maximum diameter and high uniformity of Hounsfield unit in left atrial were significant predictors of the hypercoagulable state in LAA, with better predictive efficacy than clinical characteristics. Our combined models based on machine learning were reliable for hypercoagulable state screening and anticoagulation adjustment.
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Background: Detecting cardiac thrombus in patients with acute ischemic stroke is crucial in determine stroke etiology and predict prognosis. However, the prevalence of cardiac thrombus in patients with acute ischemic stroke is unclear. Object: This study aimed to evaluate the prevalence of cardiac thrombus detected by cardiac computed tomography angiography (CCTA) in patients with acute ischemic stroke through a meta-analysis. Methods: Embase, Web of Science, MEDLINE, and CENTRAL were searched from January 1, 2000, to May 1, 2024. We included observational studies enrolling patients who underwent CCTA within 1 month following acute ischemic stroke, and reporting the incidence of cardiac thrombi on CCTA. Meta-analysis was performed using random effects models. Results: Twenty-six studies involving 4,516 patients were identified. The pooled prevalence of cardiac thrombus detected on CCTA in patients with acute ischemic stroke was 0.08 (95% confidence interval [CI]: 0.06-0.11). Inter-study heterogeneity was high (I2 = 88%). Among stroke type, the prevalence of atrial fibrillation, timing of CCTA and CCTA technology, the prevalence of atrial fibrillation was the only factor associated with cardiac thrombi prevalence detected by CCTA. However, atrial fibrillation was not documented in 41.5% of the patients with cardiac thrombi. Conclusion: CCTA is a useful non-invasive imaging approach for detecting cardiac thrombus in patients with acute ischemic stroke, which might be helpful to determine the stroke etiology.