Abstract
Background and aims: We aimed to identify characteristics associated with cardiac thrombus presence on cardiac CT acquired during the acute stroke imaging protocol in patients with acute ischemic stroke (AIS).
Methods: This pre-specified secondary analysis of the AIS of HEARTS study included patients with AIS who underwent cardiac CT during acute imaging. Associations with thrombus presence were evaluated using univariable and multivariable logistic regression models. A sensitivity analysis was performed excluding patients with known atrial fibrillation.
Results: We included 3919 patients (median age 74 [IQR 63-82] years, 58% male), of whom 243 (6.2%) had a cardiac thrombus. In the primary multivariable analysis (n=3919), higher NIHSS scores (aOR 1.06 per point, 95%CI 1.04-1.08), atrial fibrillation (aOR 2.96, 95%CI 2.10-4.18), ischemic heart disease (aOR 1.39, 95%CI 1.02-1.89), use of antihypertensive drugs (aOR 1.77, 95%CI 1.19-2.63), multivessel occlusion (aOR 1.52, 95%CI 1.03-2.24), and CT-perfusion deficit (aOR 1.98, 95%CI 1.07-3.66) were associated with cardiac thrombus presence. In the sensitivity analysis (n=3007), higher NIHSS scores (aOR 1.06, 95%CI 1.03-1.09), use of anti-hypertensives (aOR 1.77, 95%CI 1.10-2.85) and perfusion deficit (aOR 2.58, 95%CI 1.20-5.56) were associated. Thrombus prevalence ranged from 0.4% for patients with a mild stroke at base-line and absence of other associated factors, to 50% in those with severe stroke and the combined presence of all associated variables.
Conclusions: We identified clinical and radiological predictors of finding a cardiac thrombus on acute cardiac CT. These markers may help guide diagnostic decision-making in AIS patients to enhance detection of cardiac thrombi.