Inflammation and Atrial Electrical Remodelling in Patients With Embolic Strokes of Undetermined Source

Area of Science:

• Cardiology
• Neurology
• Biochemistry

Background:

• Embolic strokes of undetermined source (ESUS) constitute approximately one-third of all ischemic strokes.
• Silent atrial fibrillation (AF) is a potential cause of ESUS, with P wave dispersion (PWD) on ECG as a predictor of paroxysmal AF.
• Inflammation, measured by high-sensitive C-reactive protein (hsCRP), is associated with AF development and persistence, potentially through atrial remodeling.

Purpose of the Study:

• To investigate the relationship between P wave dispersion (PWD) and high-sensitive C-reactive protein (hsCRP) in patients diagnosed with ESUS.
• To explore the potential role of inflammation in atrial electrical remodeling that predisposes to AF in ESUS patients.

Main Methods:

• 174 patients with ESUS underwent neuroimaging, arterial ultrasound, echocardiography, and ECG.
• P wave dispersion (PWD) and hsCRP levels were measured in all participants.
• Statistical analysis, including Spearman correlation, was used to assess the relationship between hsCRP and PWD.

Main Results:

• A significant positive correlation was observed between hsCRP and PWD (Spearman r: 0.35, p<0.0001).
• Patients with high PWD (>40 msec) exhibited hsCRP levels three-fold higher than those with normal PWD (≤40 msec).
• Elevated hsCRP was significantly associated with higher PWD in the ESUS cohort (1.57±2.9 mg/dl vs 0.42±0.4 mg/dl, p=0.0005).

Conclusions:

• The study found elevated hsCRP levels in ESUS patients with high PWD, indicating a link between inflammation and atrial electrical changes.
• These findings support the hypothesis that systemic inflammation contributes to atrial electrical remodeling in a subset of ESUS patients.
• This inflammatory pathway may increase the risk of developing AF in patients with embolic strokes of undetermined source.