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Published on: September 17, 2014
Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies
Shirin Jalini1, Rajasumi Rajalingam1, Rosane Nisenbaum1
1From the Department of Medicine (Neurology) (S.J.), Queens' University, Kingston; Departments of Medicine (Neurology) (R.R., A.P.) and Medicine (Cardiology) (A.D.J., A.W.), Toronto Western Hospital/University Health Network, and Dalla Lana School of Public Health (R.N.), University of Toronto; and Centre for Urban Health Solutions (R.N.), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Insights
Atrial cardiopathy is more common in embolic stroke of unknown source (ESUS) than other stroke types. This finding suggests a distinct mechanism in ESUS, but further research is needed for targeted stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Atrial cardiopathy is a potential cause of stroke.
- Embolic stroke of unknown source (ESUS) represents a significant proportion of ischemic strokes.
- Understanding the characteristics of ESUS is crucial for effective stroke prevention.
Purpose of the Study:
- To determine the prevalence of atrial cardiopathy in patients with ESUS.
- To compare atrial cardiopathy prevalence between ESUS and other stroke etiologies (large artery atherosclerosis, small vessel disease).
- To compare clinical characteristics of ESUS patients with cardioembolic (CE) stroke patients.
Main Methods:
- Cross-sectional study of 846 ischemic stroke patients.
- Atrial cardiopathy defined by p-wave terminal force in V1 >5,000 µV·ms or severe left atrial enlargement.
- Comparison of atrial cardiopathy prevalence and baseline characteristics across stroke subtypes (ESUS, LAA, SVD, CE).
Main Results:
- Atrial cardiopathy was more prevalent in ESUS patients (26.6%) compared to LAA (12.1%) and SVD (16.9%) strokes (p=0.001).
- ESUS patients were younger, less hypertensive, with higher cholesterol/LDL, but fewer left ventricular/atrial abnormalities than CE patients.
- 158 patients (19%) met ESUS criteria.
Conclusions:
- Atrial cardiopathy is highly prevalent in ESUS, suggesting a unique thromboembolic mechanism.
- ESUS patients exhibit distinct clinical profiles compared to CE patients.
- Further research is needed to clarify the role of atrial cardiopathy in ESUS for stroke risk stratification and treatment strategies, including anticoagulation.
Objective:
To investigate the prevalence and clinical determinants of atrial cardiopathy in patients with embolic stroke of unknown source (ESUS) and compare with other established stroke etiologies.
Methods:
In a cross-sectional study of 846 consecutive patients with ischemic stroke, we compared the prevalence of atrial cardiopathy (defined by p-wave terminal force in V1 >5,000 µV·ms or severe left atrial enlargement) between ESUS patients and patients with large artery atherosclerosis (LAA) and small vessel disease (SVD) strokes. Baseline characteristics were also compared between ESUS and cardioembolic (CE) patients.
Results:
Of all, 158 (19%) patients met ESUS diagnostic criteria, while others were classified into LAA (n = 224, 26%), SVD (n = 154, 18%), and CE (n = 310, 37%). The prevalence of atrial cardiopathy was higher in ESUS patients compared to noncardioembolic stroke patients (26.6% vs 12.1% in LAA vs 16.9% in SVD; p = 0.001). ESUS patients were younger, were less hypertensive, and had higher cholesterol and low-density lipoprotein levels, but also had less left ventricular or atrial abnormalities when compared to CE patients.
Conclusion:
The prevalence of atrial cardiopathy was high in ESUS patients compared with patients with nonembolic strokes. Interestingly, ESUS patients were also clinically different from CE patients. While the presence of atrial cardiopathy may reflect a unique mechanism of thromboembolism in ESUS patients, it is still unclear if they may benefit from anticoagulation, or if the presence of atrial cardiopathy in this population could serve as a risk-stratifying marker for stroke recurrence. Further efforts are necessary to provide better characterization of the ESUS population in order to develop better stroke preventive strategies.
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