ABSTRACT NUMBER: ESOC2026A1599 BURDEN OF CARDIOVASCULAR MRI FINDINGS PROMPTING CARDIOLOGY CONSULTATIONS IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract Background and aims Cardiovascular comorbidities in patients with acute ischaemic stroke (AIS) are frequent yet underrecognized. We assessed whether cardiovascular MRI (CMR) adds meaningful diagnostic information and affects the recommendation for urgent cardiology consultation. Methods We retrospectively analysed reports of CMR examinations conducted as part of the prospective Cardiomyocyte Injury Following Acute Ischemic Stroke (CORONA-IS) study (01/2019-12/2023). Previously undiagnosed findings were considered ‘relevant’ if a cardiology consultation was recommended by experienced CMR raters blinded for clinical information. Results CMR was performed in 284/310 (91.6%) enrolled patients (median age 77 years, 42.6% female). Of these, 74/284 (26.1%) had at least one relevant pathological finding, including evidence of possible previous myocardial infarction (56/74, 75.7%), cardiomyopathy (13/74, 17.6%) and other findings (e. g. thrombus; 13/74, 17.6%). In 62/74 (83.8%) patients, the CMR finding indicated a previously undiagnosed heart condition. These patients were significantly more likely to have valvular heart disease (16.1% versus 4.3%), cortical infarcts (67.7% versus 51.0%), post-ischaemic ECG changes (29.5% versus 13.9%) and elevated hs-cardiac troponin T levels on admission (80.6% versus 61.4%) compared to those without recommendation for cardiology consultation (n=210). The underlying pathology revealed by CMR remained undetected during routine clinical in-patient work-up in 47/62 (75.8%) patients. Conclusions CMR reveals a significant burden of clinically relevant pathological findings requiring cardiology consultation, especially in patients with known valvular heart disease, cortical infarcts, post-ischaemic ECG changes and elevated troponin levels. These findings may guide the establishment of refined diagnostic pathways and triage protocols in the interdisciplinary stroke management. Conflict of interest All authors: nothing to disclose