News | April 28, 2015

"Motion-Tracking" MRI Tests Reveal Novel Harbingers of Stroke in Atrial Fibrillation Patients

Johns Hopkins study finds that altered left atrium function could indicate higher risk for those with and without AFib

Johns Hopkins, motion-tracking MRI, stroke risk, atrial fibrillation

April 28, 2015 — Researchers from Johns Hopkins performing sophisticated motion studies of heart magnetic resonance imaging (MRI) scans have found that specific altered function in the left atrium may signal stroke risk in those with atrial fibrillation and those without it.

Stroke is a frequent and dreaded complication of atrial fibrillation (afib). But predicting which of the estimated six million Americans with afib are at highest risk has long challenged physicians weighing stroke risk against the serious side effects posed by lifelong therapy with warfarin and other blood thinners.

The new imaging technique combines standard MRI scans with a motion-tracking software that analyzes cardiac muscle movement.

Reporting April 27th in the Journal of the American Heart Association, researchers said the specialized tests can pave the way to more accurate risk-gauging models and more precise therapy among with highest likelihood of stroke. The current risk-assessment guidelines underestimate that risk in about 12 percent of people with afib who would benefit from prophylactic treatment with blood thinners, researchers said. At the same time, researchers added, averting overtreatment in lower-risk patients would prevent the rare but often-devastating brain bleeds that occur as a side effect of blood-thinners.

The study results, the research teams said, also cast doubt on the current clinical dogma that chaotic beating of the upper chambers of the heart during Am12trial fibrillation fuels the blood clot formation that causes stroke. That view, the team said, has failed to explain why many people with atrial fibrillation never have strokes and why many with history of atrial fibrillation have no evidence of abnormal rhythms within a month before the stroke.

“Our research suggests that certain features of the heart’s upper left chamber that are easily seen on heart MRI could be the smoking gun we need to tell apart low-risk from high-risk patients,” said lead investigator and heart rhythm specialist Hiroshi Ashikaga, M.D., Ph.D., assistant professor of medicine and biomedical engineering at the Johns Hopkins University School of Medicine.

The investigators said just how the suppressed function and altered anatomy of the left atrium cause stroke remains unclear, but said they have reason to believe these features reflect more sluggish blood flow that leads to clot formation and precipitates stroke.

“Our observations suggest that altered function in the left atrium of the heart may lead to stroke independently of the heart rhythm disturbance itself,” said co-investigator Joao Lima, M.D., professor of medicine and radiology at the Johns Hopkins University School of Medicine and director of cardiovascular imaging at The Johns Hopkins Hospital. “What this means is that people with compromised function in the left upper portion of the heart may be at risk for stroke, with or without atrial fibrillation.”

“Maybe when it comes to stroke risk and afib, we’ve been chasing the wrong guy all along,” Ashikaga said. “Maybe atrial fibrillation itself is not the real culprit and dysfunction of the left atrium is the real baddie. It’s a possibility we have to consider and will in an upcoming study.”

The new findings are based on analysis of records of 169 Johns Hopkins patients, ages 49 to 69, with atrial fibrillation who had cardiac MRIs before undergoing a minimally invasive procedure to burn off — or ablate — small sections of heart tissue that trigger the aberrant rhythm. Eighteen of the patients had suffered minor or major strokes prior to their ablations.

Using the enhanced motion imaging, the investigators compared images of the hearts of patients who had suffered strokes with those who had not, noticing several marked differences.

First, the left atria of patients who’d had strokes had notably reduced ability to empty out blood into the lower portion of the heart, an average of 35 percent per minute in patients with strokes, compared with 46 percent among those without strokes. In addition, the left atria were bigger and more dilated in patients who’d suffered strokes, an average volume of 52 milliliters per meter squared in stroke patients, compared with 44 in those without stroke. Finally, the left atria of patients who’d suffered strokes had worse overall ability to stretch out and recoil with each heartbeat, meaning that the heart muscle in this area of the heart was not as elastic and as capable of accommodating strain. Taken together, the researchers say, these features indicate that patients who’d suffered strokes had suppressed function and slower blood turnover in this portion of their heart muscle.

The research team is next planning to test the predictive value of this imaging approach in patients with and without atrial fibrillation, follow them closely and track their stroke risk over time.

For more information: www.hopkinsmedicine.org

Related Content

Radiographer Apollo Exconde with his Lego concept open MRI for patient education.

Radiographer Apollo Exconde with his Lego concept open MRI for patient education.

News | Patient Engagement | November 11, 2019
November 11, 2019 — Radiographer Apollo Exconde...
Image by Dr. Manuel González Reyes from Pixabay

Image by Dr. Manuel González Reyes from Pixabay 

News | SPECT Imaging | November 08, 2019
November 8, 2019 — Using ground-breaking technology, researchers at the...
This chest X-ray of a patient being treated for e-cigarette or vaping-associated lung injury shows lung opacities, densities and whitish cloud-like areas which are typically seen with unusual pneumonias, fluid in lungs or lung inflammation. Image courtesy of Intermountain Healthcare

This chest X-ray of a patient being treated for e-cigarette or vaping-associated lung injury shows lung opacities, densities and whitish cloud-like areas which are typically seen with unusual pneumonias, fluid in lungs or lung inflammation. Image courtesy of Intermountain Healthcare

News | Clinical Trials | November 08, 2019
November 8, 2019 — As the outbreak of lung injuries and deaths associated with e-cigarettes, or...
Unlike other technologies for imaging the placenta, pCASL MRI can distinguish maternal blood from fetal blood

Image courtesy of Pixabay

News | Clinical Trials | November 07, 2019
November 7, 2019 — A new imaging technique to track
The introduction of liquid helium free, high-end MRI systems by MR Solutions substantially reduces the environmental impact
News | Magnetic Resonance Imaging (MRI) | November 05, 2019
November 5, 2019 — Environmental impact is becoming a significant factor in the selection of suppliers even in precli
MRI control room at Centra DuPage Hospital
News | Magnetic Resonance Imaging (MRI) | November 04, 2019
November 4, 2019 — Traditional image-guided procedures remained restricted to the limitation of physicians referring
The Neuroreader software program quantifies brain volume in study participants with TBI

The Neuroreader software program quantifies brain volume in study participants with TBI. Image courtesy of UCLA Health.

News | Clinical Trials | October 29, 2019
October 29, 2019 — A UCLA-led...
An example of a semitruck trailer-based mobile MRI suite.

An example of a semitruck trailer-based mobile MRI suite, similar to the one involved in the accident.

Feature | Magnetic Resonance Imaging (MRI) | October 25, 2019 | Dave Fornell
A radiology nurse was seriously injured Oct. 23 at Sunderby Hospital in Luleå, located in northern Sweden, when caught...
Breast Tomosynthesis Increases Cancer Detection Over Digital Mammography
News | Mammography | October 23, 2019
Screening digital breast tomosynthesis (DBT) results in “significantly increased CDR [cancer detection rates]” compared...
NVIDIA and King's College London Debut First Privacy-preserving Federated Learning System

Image courtesy of NVIDIA

News | Artificial Intelligence | October 23, 2019
To help advance medical research while preserving data privacy and improving patient outcomes for brain tumor...