ABSTRACT NUMBER: ESOC2026A354 CLINICAL AND IMAGING CHARACTERISTICS ASSOCIATED WITH CARDIAC THROMBUS DETECTION ON CARDIAC CT IN ACUTE ISCHEMIC STROKE

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 antihypertensives (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 baseline 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. Conflict of interest The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SSN received travel grants from the Cultuurfondsbeurs, Remmert Adriaan Laan Fonds, CONTRAST consortium and Dr. Jan Meerwaldt Stichting outside the submitted work. DSG repports funding by the Australian Government Research Training Program Scholarship. ABN has received research funding from the Neurological Foundation of New Zealand, outside the submitted work. CGE has received travel funding for travel for conferences from Boehringer Ingelheim and Bayer and speaker honoraria from Astra Zeneca, outside the submitted work. JMC reports grants from Medtronic, Siemens, AstraZeneca and Bayer outside the submitted work (all paid to institution). JMC is shareholder and co-founder of TrianecT. LAR was supported by a personal Dekker Junior Clinical Scientist Grant from the Dutch Heart Foundation. The other authors have no financial conflicts of interest.