Total Bolus Transit Time Predicts Cardiac Dysfunction in Acute Ischemic Stroke and Transient Ischemic Attack Patients: A Retrospective Double Center Study

ABSTRACT Background Diagnosing cardioembolic stroke/transient ischemic attack (TIA) rapidly remains a major challenge. Current emergency cardiac assessments often provide insufficient data. This study tests whether bolus tracking, a readily available technique during brain CTA, can be leveraged to quickly identify reduced ejection fraction (EF) and potential cardioembolic etiology in acute stroke patients. Patients and Methods We retrospectively analyzed CTA and echocardiography data from acute ischemic stroke/TIA patients across two comprehensive stroke centers. We measured total transit time (TTT) based on aortic attenuation values of 40 Hounsfield Units (T40HU) and 100 HU (T100HU) obtained during routine CTA. ΔT100–T40HU, representing the time difference required for aortic contrast enhancement to increase from 40 to 100 HU, was also calculated as a key parameter. EF was measured by transthoracic echocardiography using the Simpson biplane method. Results In a cohort of 443 patients, we found a statistically significant inverse correlation between EF and T40HU, T100HU, and ΔT100–T40HU. Notably, ΔT100–T40HU demonstrated good discriminatory ability for identifying heart failure (AUROC = 0.88) and poor discriminatory ability for cardioembolic stroke (AUROC = 0.66). Multivariate analysis further confirmed that T40HU, T100HU, and ΔT100–T40HU were independent predictors of both heart failure and cardioembolic stroke based on the TOAST classification criteria. Conclusion Bolus tracking during CTA provides a reliable and easily accessible radiological tool for the identification of heart failure and cardioembolic stroke, enabling a faster diagnostic workup and facilitating appropriate selection of further diagnostic investigations within the acute emergency setting.