Expert opinion paper on cardiac imaging after ischemic stroke

This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the Heart and Brain consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

Automated summary

This expert opinion paper highlights the importance of cardiac imaging in the etiological work-up after stroke, emphasizing the use of enhanced echocardiographic tools and advanced cardiac imaging techniques. While certain imaging findings may lead to changes in medical secondary stroke prevention or treatment, there is currently no evidence from randomized controlled trials to suggest that the choice of imaging method directly impacts stroke patient prognosis. The German Heart and Brain consortium offers an interdisciplinary, staged standard diagnostic scheme for detecting risk factors of cardio-embolic stroke.