Cardiac Stasis Imaging, Stroke and Silent Brain Infarcts in Patients with Non-Ischemic Dilated Cardiomyopathy

Background: Cardioembolic stroke is one of the most devastating complications of non-ischemic dilated cardiomyopathy (NIDCM). However, in clinical trials of primary prevention, the benefits of anticoagulation were hampered by the risk of bleeding. If indices of cardiac blood stasis account for the risk of stroke, they may be useful to individualize primary prevention treatments. Methods: We performed a cross-sectional study in patients with NIDCM and no history of atrial fibrillation (AF) from two sources: 1) a prospective enrollment of unselected patients with left ventricular (LV) ejection fraction <45% and 2) a retrospective identification of patients with a history of previous cardioembolic neurological event. The primary endpoint integrated a history of ischemic stroke, transient ischemic attack (TIA), or the presence intraventricular thrombus, or a silent brain infarction (SBI) by imaging. From echocardiography, we calculated blood flow inside the LV and its residence time (RT). The study was registered in ClinicalTrials.gov ([NCT03415789][1]). Results: Of the 89 recruited patients, 18 showed a positive primary endpoint: 9 patients had a history stroke or TIA and another 9 were diagnosed with SBIs in the brain imaging. RT performed good to identify the primary endpoint (AUC (95% CI)= 0.75 (0.61-0.89), p= 0.001). A RT > 2.21 cycles showed a sensitivity of 0.88 (0.77-1.00) and specificity of 0.70 (0.10-0.81). When accounting only for identifying a history of stroke or TIA, AUC for RT was 0.92 (0.85-1.00) with and odds ratio= 7.2 (2.3 – 22.3) per cycle, p< 0.001. Conclusions: In patients with NIDCM in sinus rhythm, stasis imaging derived from echocardiographyis is closely related to the burden of stroke. Stasis imaging may be useful to address stroke risk in patients with systolic dysfunction. ### Competing Interest Statement P.M.-L., J.C.A., 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 NCT03415789 ### Funding Statement This study was supported by the Spanish Society of Cardiology (ISBIDCM), by the Instituto de Salud Carlos III (PACER-1 PI21/00274) 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 by a grant of Spanish Cardiology Society, and the Fundación para la Investigación Biomédica Hospital Gregorio Marañón was the unique sponsor 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 Data will be available upon reasonable request to the authors. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03415789&atom=%2Fmedrxiv%2Fearly%2F2024%2F03%2F24%2F2024.03.22.24304765.atom