The International Journal of Cardiovascular Imaging

, Volume 27, Issue 7, pp 1035–1044 | Cite as

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

  • Yeonyee E. Yoon
  • Hyuk-Jae Chang
  • Iksung Cho
  • Ki-Hyun Jeon
  • Eun-Ju Chun
  • Sang-il Choi
  • Hee-Jun Bae
  • Juan J. Rivera
  • Khurram Nasir
  • Roger S. Blumenthal
  • Tae-Hwan Lim
Original Paper

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

Stroke Coronary artery disease Cardiac computed tomography Diagnosis 

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Copyright information

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

Authors and Affiliations

  • Yeonyee E. Yoon
    • 1
  • Hyuk-Jae Chang
    • 2
  • Iksung Cho
    • 1
  • Ki-Hyun Jeon
    • 1
  • Eun-Ju Chun
    • 3
  • Sang-il Choi
    • 3
  • Hee-Jun Bae
    • 4
  • Juan J. Rivera
    • 5
    • 6
  • Khurram Nasir
    • 5
    • 7
  • Roger S. Blumenthal
    • 5
  • Tae-Hwan Lim
    • 8
  1. 1.Division of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Division of CardiologySeverance Cardiovascular HospitalSeoulRepublic of Korea
  3. 3.Department of RadiologySeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
  5. 5.Johns Hopkins Ciccarone Preventive Cardiology CenterBaltimoreUSA
  6. 6.South Beach Preventive CardiologyMiami BeachUSA
  7. 7.Cardiac MR PET CT Program, Massachusetts General HospitalHarvard School of MedicineBostonUSA
  8. 8.Department of RadiologyUlsan University HospitalSeoulSouth Korea

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