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Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography

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Abstract

The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.

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Acknowledgments

This study was supported by a grant (A060171) of the Korea Health 21 R&D project, Ministry of Health, Welfare and Family Affairs, Republic of Korea.

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Authors and Affiliations

  1. Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea

    Yeonyee E. Yoon, Iksung Cho & Ki-Hyun Jeon

  2. Division of Cardiology, Severance Cardiovascular Hospital, 250 Seongsan-no Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Hyuk-Jae Chang

  3. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Eun-Ju Chun & Sang-il Choi

  4. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hee-Jun Bae

  5. Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA

    Juan J. Rivera, Khurram Nasir & Roger S. Blumenthal

  6. South Beach Preventive Cardiology, Miami Beach, FL, USA

    Juan J. Rivera

  7. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard School of Medicine, Boston, MA, USA

    Khurram Nasir

  8. Department of Radiology, Ulsan University Hospital, Seoul, South Korea

    Tae-Hwan Lim

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  1. Yeonyee E. Yoon
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Correspondence to Hyuk-Jae Chang.

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Yoon, Y.E., Chang, HJ., Cho, I. et al. Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. Int J Cardiovasc Imaging 27, 1035–1044 (2011). https://doi.org/10.1007/s10554-010-9743-8

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  • DOI: https://doi.org/10.1007/s10554-010-9743-8

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