# Cardiac Imaging of Neuro-Embolic Mechanisms in Atriopathies causing Stroke (CINEMAS)

> **NIH NIH R01** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2024 · $1,780,257

## Abstract

Project Summary
Stroke is one of the leading causes of death and remains a major cause of disability with over 25 million
individuals worldwide living with its consequences. Manifest atrial fibrillation (AF) accounts for 10% of all
strokes, predominantly due to thromboembolism from the left atrium (LA). Despite thorough diagnostic
evaluation, 20-30% of ischemic strokes are classified as cryptogenic or of unknown cause. Most cryptogenic
strokes have an embolic appearance, known as embolic stroke of undetermined source (ESUS). A substantial
portion of patients with ESUS will eventually be diagnosed with AF. Recent findings support the notion that an
underlying disease of the LA (atrial cardiopathy), which may lead to AF, may also independently result in
thrombus formation and increase stroke risk in the absence of AF. LA appendage (LAA) stasis is linked to
atrial thrombus formation as part of Virchow’s triad. Our preliminary work on LA 4D flow MRI (4DMRI) provides
a novel noninvasive tool that assesses LAA stasis and could provide a new paradigm for stroke prevention.
Other biomarkers of atrial cardiopathy have already been associated with greater risk of development of AF
and stroke, including atrial size/morphology, ECG P wave morphology, atrial strain on echocardiography,
epicardial adipose tissue (EAT), troponin and N terminal pro-brain natriuretic peptide levels. Yet, none are
currently used for clinical decision making. The overall goal of this research is to identify clinical and
mechanistic characteristics of 4DMRI-derived LAA stasis in order to identify optimal strategies to prevent
recurrent stroke in patients with ESUS. It is anticipated that this mechanistic assessment for risk of atrial
thrombus formation will also provide improved utility for stroke prevention in AF. We will prospectively study
patients with ESUS at 4 experienced centers with heart-brain MRI, assessing LAA stasis by 4DMRI and other
atrial cardiopathy markers in a comprehensive manner. Specific aims are to : 1) Evaluate 4DMRI LA/LAA
stasis and other atrial cardiopathy biomarkers in patients with ESUS (Group 1, n=229), cardioembolic stroke
due to AF (Group 2, n=80), no stroke or AF (Group 3, n=80), and no stroke but with AF (Group 4, n=80). We
will assess the diagnostic utility of LA/LAA stasis and other atrial cardiopathy biomarkers for cardioembolic
stroke due to AF; 2) Assess the clinical factors predicting progression of LA/LAA stasis in 229 ESUS patients
by repeating MRI at 2 years; 3) Determine whether LAA stasis and/or other atrial cardiopathy biomarkers are
predictors of recurrent ischemic stroke (primary endpoint) and new AF (secondary) in 229 patients with ESUS.
We hypothesize that LAA stasis will be the strongest independent predictor of recurrent ischemic stroke. This
proposal, Cardiac ImagiNg of Embolic Mechanisms in Atriopathies causing Stroke (CINEMAS), focuses on
optimizing the diagnosis of atrial cardiopathy in patients with ESUS. Improved diagnosis wit...

## Key facts

- **NIH application ID:** 10882523
- **Project number:** 1R01HL170019-01A1
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** Jeremy Douglas Collins
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,780,257
- **Award type:** 1
- **Project period:** 2024-05-01 → 2029-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10882523

## Citation

> US National Institutes of Health, RePORTER application 10882523, Cardiac Imaging of Neuro-Embolic Mechanisms in Atriopathies causing Stroke (CINEMAS) (1R01HL170019-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10882523. Licensed CC0.

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