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Previously Undetected Myocardial Scarring Associated With Post-Stroke Outcomes
In a study recently published in JACC: Cardiovascular Imaging, PD Dr. Simon Hellwig, Fellow of the BIH Charité Clinician Scientist Program, and Prof. Dr. Jan F. Scheitz, Fellow of the BIH Charité Advanced Clinician Scientist Pilotprogram, report novel insights into the prognostic relevance of myocardial scarring in patients after ischemic stroke.
The investigators evaluated cardiac MRI scans from nearly 700 stroke patients recruited at five international centers in Germany, Switzerland, and the United States, all of whom had no prior diagnosis of cardiac disease. Notably, myocardial fibrosis was detected in approximately one-third of patients. The imaging characteristics of these scars allowed differentiation of potential underlying etiologies, such as prior coronary artery disease or myocarditis. A smaller proportion of patients demonstrated multiple scar patterns, suggestive of coexisting cardiac pathologies. At three-month follow-up, patients with previously unrecognized myocardial scarring exhibited an almost twofold increased risk of unfavorable functional outcome, operationalized as significant impairment in activities of daily living. Moreover, evidence indicated that the coexistence of myocardial scars of presumably different etiologies was particularly associated with adverse trajectories, including both poorer functional recovery and higher incidence of recurrent major cardiovascular events. The authors emphasize that systematic detection of such previously undiagnosed myocardial scars may enable early identification of stroke patients at elevated risk for poor prognosis and recurrent cardiovascular complications. This subgroup could benefit from intensified diagnostic evaluation and tailored therapeutic strategies. Taken together, the findings underline the relevance of silent heart disease among patients with ischemic stroke and the need for interdisciplinary, neuro-cardiological prevention measures.