The International Journal of Cardiovascular Imaging

, Volume 27, Issue 7, pp 1035–1044

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

Authors

  • Yeonyee E. Yoon
    • Division of Cardiology, Cardiovascular CenterSeoul National University Bundang Hospital
    • Division of CardiologySeverance Cardiovascular Hospital
  • Iksung Cho
    • Division of Cardiology, Cardiovascular CenterSeoul National University Bundang Hospital
  • Ki-Hyun Jeon
    • Division of Cardiology, Cardiovascular CenterSeoul National University Bundang Hospital
  • Eun-Ju Chun
    • Department of RadiologySeoul National University Bundang Hospital
  • Sang-il Choi
    • Department of RadiologySeoul National University Bundang Hospital
  • Hee-Jun Bae
    • Department of NeurologySeoul National University Bundang Hospital
  • Juan J. Rivera
    • Johns Hopkins Ciccarone Preventive Cardiology Center
    • South Beach Preventive Cardiology
  • Khurram Nasir
    • Johns Hopkins Ciccarone Preventive Cardiology Center
    • Cardiac MR PET CT Program, Massachusetts General HospitalHarvard School of Medicine
  • Roger S. Blumenthal
    • Johns Hopkins Ciccarone Preventive Cardiology Center
  • Tae-Hwan Lim
    • Department of RadiologyUlsan University Hospital
Original Paper

DOI: 10.1007/s10554-010-9743-8

Cite this article as:
Yoon, Y.E., Chang, H., Cho, I. et al. Int J Cardiovasc Imaging (2011) 27: 1035. doi:10.1007/s10554-010-9743-8

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.

Keywords

StrokeCoronary artery diseaseCardiac computed tomographyDiagnosis

Copyright information

© Springer Science+Business Media, B.V. 2010