Introduction: Stroke survivors most likely die of cardiac death, yet few undergo comprehensive cardiac assessment to look for reversible causes. Myocardial fibrosis (MF) is a substrate for sudden cardiac death. We recently showed that MF in stroke survivors can be treated by spironolactone and amiloride in a randomised placebo-controlled cross-over study (1). Methods: We aim to determine the prevalence of severe MF in stroke survivors, as evidenced by Procollagen carboxyl-terminal telopeptide (PICP)>127 µg/L (specificity: 78%, sensitivity: 75%) (2). We also tested the hypothesis that PICP is associated with reversible cardiac pathologies in stroke survivors. Myocardial perfusion imaging was performed using dipyridamole as stressor (if not contraindicated). Ejection fraction was determined using GATED SPECT. Left ventricular mass index (LVMI) was determined by echocardiography. Patients who were known to have liver or lung fibrosis or recent surgery (within 6 months), or atrial fibrillation were excluded at recruitment because these conditions could affect PICP level. Results: 186 stroke survivors were studied. Severe MF is prevalent amongst stroke survivors. 36% (67 out of 186) had PICP >127 µg/L. Stroke survivors with severe fibrosis were older [68 (1.2) vs 65 (0.9), p=0.049], but had similar blood pressure (144/79 mmHg in severe fibrosis patients, vs 144/80 mmHg), history of angina or myocardial infarction and degree of inducible ischaemia (2.3, 95% CI 1.2-3.4; vs 2.3, 95% CI 1.5-3.1) when compared with those with lower PICP levels. There was a very weak correlation between PICP and LVMI [r=0.2, p=0.011]. No correlation was found between PICP and ejection fraction or BNP levels or QT dispersion. Interestingly, stroke survivors taking ACE-inhibitors had less severe MF (Mantel-Haenszel OR=0.3, 95%CI=0.15-0.74; Fisher’s exact 2-sided p=0.007). Conclusions: Severe MF is common in stroke survivors. Stroke survivors taking ACE-inhibitors had less severe myocardial fibrosis. Whilst a statistically significant association was found between MF and LVMI, the correlation is very weak.