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Atrial cardiomyopathy in patients with ischaemic stroke: a cross-sectional and prospective cohort study-the COAST
Bjørn Strøier Larsen1, Mark Aplin2, Nis Høst2
1Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Hospital, Copenhagen, Denmark blar0160@regionh.dk.
Insights
Cardiac magnetic resonance imaging assesses atrial cardiomyopathy in unexplained ischemic stroke. This condition, characterized by left atrial abnormalities, may increase stroke risk beyond detected atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Approximately 25% of ischemic stroke cases remain unexplained after thorough investigation.
- Paroxysmal atrial fibrillation is often suspected but frequently undetected, and its clinical relevance threshold is unclear.
- Atrial cardiomyopathy, encompassing left atrial structural and functional abnormalities, is an emerging risk factor for ischemic stroke, with atrial fibrillation being one component.
Purpose of the Study:
- To evaluate atrial cardiomyopathy using cardiac magnetic resonance (CMR) in patients with stroke of undetermined aetiology.
- To compare atrial cardiomyopathy findings between patients with undetermined stroke, known stroke mechanisms, and healthy controls.
- To investigate the association between left atrial abnormalities and ischemic stroke risk.
Main Methods:
- A cross-sectional and prospective cohort study involving 100 recent ischemic stroke patients and 50 controls.
- Cardiac magnetic resonance (CMR) imaging to assess left atrial (LA) structural and functional abnormalities, including atrial fibrosis.
- Follow-up for recurrent ischemic stroke, atrial fibrillation (AF), and cardiovascular death over 18 months post-inclusion.
Main Results:
- The primary endpoint is the extent of CMR-assessed atrial fibrosis in the LA at baseline.
- The study is powered to detect a 6% difference in LA fibrosis between stroke groups.
- Analysis will compare LA fibrosis and other structural/functional abnormalities across patient cohorts.
Conclusions:
- Cardiac magnetic resonance imaging can identify and quantify atrial cardiomyopathy.
- Atrial cardiomyopathy may play a significant role in cryptogenic ischemic stroke.
- Further research is needed to clarify the role of atrial cardiomyopathy in stroke aetiology and risk stratification.
Introduction:
Despite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed 'atrial cardiomyopathy'. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease.
Methods And Analysis:
This cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and functional abnormalities with CMR. Inclusion began in March 2019, and follow-up is planned to be complete in January 2023. There are two scheduled follow-ups: (1) 18 months after individual inclusion, counting from the index diagnostic MRI of the brain, (2) end of study follow-up at 18 months after inclusion of the last patient, assessing the incidence of recurrent ischaemic stroke, AF and cardiovascular death. The primary endpoint is the extent of CMR-assessed atrial fibrosis in the LA at baseline. The study is powered to detect a difference of 6% fibrosis between stroke of undetermined aetiology and stroke of known mechanism with a SD of 9%, a significance level of 0.05, and power of 80%.
Ethics And Dissemination:
This study has been approved by the Danish National Committee on Health Research Ethics (H-18055313). All participants in the study signed informed consent. Results from the study will be published in peer-reviewed journals regardless of the outcome.
Trial Registration Number:
NCT03830983.
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