{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:43:35Z","timestamp":1777365815836,"version":"3.51.4"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>We aimed to use contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging to elucidate the prevalence of left ventricular (LV) thrombus in patients suspected of embolic stroke of undetermined source (ESUS) with previous myocardial infarction or LV dysfunction (LV ejection fraction [LVEF] &lt;50%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>We prospectively investigated 797 consecutive patients who presented to our hospital with acute ischemic stroke between 2014 and 2015. Patients with myocardial infarction or LVEF&lt;50% underwent CE-CMR imaging. ESUS was diagnosed according to proposal criteria based on transthoracic echocardiography findings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              The prevalence of ESUS was 22% (178 of 797) on initial diagnosis. Among 60 patients with myocardial infarction or LVEF&lt;50%, the stroke subtypes were as follows: small artery disease, 17% (10 of 60); large artery atherosclerosis, 5% (3 of 60); cardioembolic stroke, 49% (29 of 60); ESUS, 23% (14 of 60); and undetermined causes other than ESUS, 6% (4 of 60). Of 60 patients examined via CE-CMR, LV thrombus was confirmed in 12 patients, whereas only 1 had been detected on transthoracic echocardiography (\n              <jats:italic>P<\/jats:italic>\n              =0.04). Importantly, 29% (4 of 14) of patients with ESUS had LV thrombus. A prediction model based on CE-CMR findings showed higher performance in LV thrombus detection, permitting a net improvement of 0.46 (95% confidence interval, 0.08\u20130.82;\n              <jats:italic>P<\/jats:italic>\n              =0.016) in cardioembolic stroke reclassification. Compared with patients without LV thrombus, those with LV thrombus had lower LVEF (median: 26% versus 40%;\n              <jats:italic>P<\/jats:italic>\n              =0.003). Notably, 42% (5 of 12) of patients with LV thrombus had LVEF\u226530%.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>When ESUS-suspected patients have myocardial infarction or LV dysfunction, CE-CMR may help improve detection of cardioembolic stroke and provide relevant information for anticoagulation therapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02251665.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.117.018263","type":"journal-article","created":{"date-parts":[[2017,8,18]],"date-time":"2017-08-18T01:00:15Z","timestamp":1503018015000},"page":"2434-2440","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source"],"prefix":"10.1161","volume":"48","author":[{"given":"Junji","family":"Takasugi","sequence":"first","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Yamagami","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teruo","family":"Noguchi","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Morita","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomotaka","family":"Tanaka","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinori","family":"Okuno","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Yasuda","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Toyoda","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasufumi","family":"Gon","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Todo","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Sakaguchi","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuyuki","family":"Nagatsuka","sequence":"additional","affiliation":[{"name":"From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (J.T., Y.G., K.T., M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70310-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.016414"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000044389.51236.91"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.08.021"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.03.017"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2012.06.029"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2011.03.017"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-314023"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000360073"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.016227"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017706242"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20617"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.490896"},{"key":"e_1_3_2_15_2","first-page":"VI94","article-title":"Incidence of thromboembolic events in congestive heart failure. 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