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Atrial Cardiopathy and Cryptogenic Stroke

Yuji Kato1, Shinichi Takahashi1

  • 1Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.

Frontiers in Neurology
|March 11, 2022
PubMed

Insights

Atrial cardiopathy, characterized by atrial dysfunction, can cause stroke before atrial fibrillation (AF) develops. Identifying this condition may prevent cryptogenic strokes.

Area of Science:

  • Cardiology
  • Neurology
  • Pathophysiology

Background:

  • Pathophysiological advances suggest atrial substrate abnormalities can lead to embolic stroke independently of atrial fibrillation (AF).
  • Atrial cardiopathy, defined as atrial structural and functional disorders, may precede AF development and contribute to stroke risk.
  • Cryptogenic stroke, a stroke of unknown origin, may be linked to underlying atrial cardiopathy.

Purpose of the Study:

  • To provide a comprehensive overview of atrial cardiopathy and its association with cryptogenic stroke.
  • To summarize current knowledge on the pathogenesis, biomarkers, and therapeutic interventions for atrial cardiopathy.
  • To explore the potential of atrial cardiopathy as a therapeutic target for stroke prevention.

Main Methods:

  • A narrative review of studies identified through a PubMed database search.
  • Synthesis of recent findings on atrial cardiopathy, including its pathophysiology, diagnostic markers, and clinical implications.
  • Analysis of the relationship between atrial cardiopathy and cryptogenic stroke, and potential treatment strategies.

Main Results:

  • Atrial cardiopathy can cause embolic strokes before the clinical manifestation of AF.
  • Promising biomarkers for atrial cardiopathy include P-wave terminal force in lead V1, N-terminal pro-brain natriuretic peptide, and left atrial enlargement.
  • Atrial cardiopathy is considered a spectrum disorder, and its role as a therapeutic target is under investigation.

Conclusions:

  • Atrial cardiopathy represents a significant substrate for embolic stroke, potentially explaining cryptogenic strokes in some patients.
  • Further research is needed to establish optimal diagnostic criteria and therapeutic targets for atrial cardiopathy.
  • The ARCADIA trial is investigating atrial cardiopathy as a target for anticoagulation therapy to prevent stroke.

Keywords:
atrial cardiopathyatrial dysfunctionatrial fibrillationcardioembolic stroke subtypeembolic stroke of undetermined source

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