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Atrial cardiopathy in embolic stroke of undetermined source

Jing Chen1, Fenglian Gao2, Wenhong Liu2

  • 1Department of Neurology, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.

Brain and Behavior
|May 4, 2021
PubMed

Insights

Atrial cardiopathy, indicated by severe left atrial enlargement, is more common in embolic stroke of undetermined source (ESUS) than other stroke types. Patients with atrial cardiopathy and ESUS show milder symptoms and better outcomes compared to those with atrial fibrillation-induced cardioembolism.

Area of Science:

  • Cardiology
  • Neurology
  • Thromboembolism Research

Background:

  • Atrial cardiopathy is a frequent cause of thromboembolism in embolic stroke of undetermined source (ESUS).
  • Identifying atrial cardiopathy in ESUS is crucial for understanding stroke etiology and preventing recurrence.

Purpose of the Study:

  • To determine the incidence of atrial cardiopathy in ESUS patients.
  • To compare the prevalence of atrial cardiopathy in ESUS with large artery atherosclerosis (LAA) and small vessel disease (SVD) stroke subtypes.
  • To compare clinical characteristics of ESUS patients with atrial cardiopathy (AC-ESUS) against atrial fibrillation-induced cardioembolism (AF-CE) stroke.

Main Methods:

  • Retrospective analysis of 936 patients with acute ischemic stroke confirmed by diffusion-weighted imaging.
  • Atrial cardiopathy defined by severe left atrial enlargement (sLAE) or elevated NT-proBNP (>250 pg/ml).
  • Incidence of atrial cardiopathy assessed in ESUS, LAA, SVD, and AF-CE stroke groups; clinical features compared between AC-ESUS and AF-CE.

Main Results:

  • The incidence of severe left atrial enlargement (sLAE) was significantly higher in ESUS patients (5.3%) compared to LAA (1.6%) and SVD (1.2%) strokes.
  • Elevated NT-proBNP levels did not differ significantly between ESUS and other stroke subtypes.
  • AC-ESUS patients exhibited milder clinical manifestations, less hemorrhagic transformation, and better short-term outcomes than AF-CE patients.

Conclusions:

  • Severe left atrial enlargement is a more prevalent indicator of atrial cardiopathy in ESUS compared to non-cardioembolic stroke subtypes.
  • Atrial cardiopathy in ESUS presents with less severe clinical features and better short-term prognosis than atrial fibrillation-induced cardioembolic stroke.
Abstract

Keywords:
N-terminal pro-B-type natriuretic peptideatrial cardiopathyembolic stroke of undetermined sourcesevere left atrial enlargement

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