Stasis Imaging Predicts the Risk of Cardioembolic Stroke Related to Acute Myocardial Infarction

Background In the setting of ST-segment elevation myocardial infarction (STEMI), imaging-based biomarkers could be useful for guiding oral anticoagulation for primary prevention of stroke. Objectives To test the efficacy of intraventricular blood stasis imaging for predicting a composite primary endpoint of cardioembolic risk during the first 6 months after STEMI. Methods The Imaging Silent Brain Infarct in Acute Myocardial Infarction (ISBITAMI, [NCT02917213][1]) was a prospective clinical study including patients with a first STEMI, an EF ≤ 45% and without atrial fibrillation. Patients underwent ultrasound-based stasis imaging at enrollment followed by heart and brain magnetic resonance at 1-week and at 6-month visits. From the stasis maps, we calculated the average residence time, R T , of blood inside the LV and assessed its performance to predict the primary endpoint. Apical longitudinal strain was quantified by speckle tracking. Results A total of 68 patients were univocally assigned to the primary endpoint. Of them, 19 patients suffered one or more events: 3 strokes, 5 silent brain infarctions, and 15 mural thromboses. No systemic embolisms were observed. R T (OR: 3.28, 95% CI: 1.61-6.67, p=0.001) and apical strain (OR: 1.48, 95% CI: 1.14-1.92, p= 0.002) showed complementary prognostic value. The bivariate model showed a c-index= 0.84 (0.73-0.95) a negative predictive value of 1.00 (0.93-1.00) and positive predictive value of 0.45 (0.39 - 0.80). Results were confirmed in a multiple imputation sensitivity analysis. Conventional ultrasound-based metrics were of limited predictive value. Conclusions In patients with STEMI and LV systolic dysfunction in sinus rhythm, the risk of cardioembolic stroke can be accurately predicted by echocardiography combining stasis and strain imaging. ### Competing Interest Statement P.M.-L., J.C.A., R.Y, and J.B. are inventors of a method for quantifying intracardiac stasis and shear stresses from imaging data under a Patent Cooperation Treaty application (WO2017091746A1). Rest of the authors: Nothing to disclose ### Clinical Trial NCT 02917213 ### Funding Statement This study was supported by the Instituto de Salud Carlos III (PI15/02211-ISBITAMI and DTS/1900063 -ISBIFLOW), the Comunidad de Madrid (Synergy Grant: Y2018/BIO-4858 PREFI-CM) and by the EU?European Regional Development Fund. JCdA was partially supported from NIH grants R01HL158667 and NIH R01HL160024. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of the Hospital Gregorio Marañón approved the study and all patients provided written informed consent. The study was academically funded, and the Fundación para la Investigación Biomédica Hospital Gregorio Marañón was the unique sponsor. The work conforms to the principles outlined in the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02917213&atom=%2Fmedrxiv%2Fearly%2F2023%2F09%2F18%2F2023.09.15.23295650.atom