Related Experiment Video
Updated: Jul 10, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prevalence and Prognostic Value of Atrial Cardiopathy in Embolic Stroke of Undetermined Source
Yueyang Wu1,2, Xiaomeng Yang3,4, Jing Jing3,4
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, wuyueyang0507@163.com.
Insights
Elevated P-wave terminal force in lead V1 (PTFV1) significantly increases stroke recurrence and mortality risk in embolic stroke of undetermined source (ESUS) patients. Left atrial enlargement also shows a trend toward higher recurrence risk.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Embolic stroke of undetermined source (ESUS) represents a significant clinical challenge.
- Atrial cardiopathy markers are increasingly recognized as potential contributors to ESUS.
- Understanding these markers is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the prevalence of atrial cardiopathy markers in ESUS patients.
- To assess the association between these markers and adverse outcomes (death, stroke recurrence).
- To compare marker prevalence between ESUS and other ischemic stroke subtypes.
Main Methods:
- Utilized data from the Third China National Stroke Registry.
- Consecutively recruited patients with transient ischemic attack or ischemic stroke.
- Compared atrial cardiopathy markers (e.g., LA enlargement, PTFV1) between ESUS and other stroke types.
- Employed Cox regression analysis to evaluate associations with stroke recurrence and mortality.
Main Results:
- Identified 2,415 ESUS patients from 8,528 ischemic stroke cases.
- Elevated PTFV1 was significantly associated with increased 1-year stroke recurrence (HR: 2.50) and mortality (HR: 3.76) in ESUS.
- Moderate-severe LA enlargement showed a trend towards increased stroke recurrence (HR: 1.95).
- LA diameter and LA diameter index were associated with stroke recurrence in ESUS patients.
Conclusions:
- PTFV1 is an independent predictor of elevated stroke recurrence and mortality risk in ESUS.
- LA enlargement demonstrated a trend towards a correlation with higher stroke recurrence risk post-ESUS.
- These findings highlight specific atrial cardiopathy markers for risk assessment in ESUS.
Introduction:
We utilized data from the Third China National Stroke Registry to investigate the prevalence of atrial cardiopathy markers in patients with embolic stroke of undetermined source (ESUS) and to assess their association with death and stroke recurrence.
Methods:
In China, patients experiencing transient ischemic attack or ischemic stroke were recruited consecutively by the Third China National Stroke Registry. We compared atrial cardiopathy markers, such as left atrial (LA) enlargement, increased P-wave terminal force in lead V1 (PTFV1), premature atrial contractions, paroxysmal supraventricular tachycardia, advanced interatrial block, prolonged PR interval, prolonged P-wave dispersion, and prolonged P-wave duration between ESUS patients and those with small vessel disease and large artery atherosclerosis strokes. The association between these markers and the recurrence of stroke as well as mortality risk in ESUS patients was evaluated using Cox regression analysis.
Results:
Of 8,528 ischemic stroke patients who underwent a standard diagnostic workup, 2,415 were identified as having ESUS. Multivariable analysis revealed a significant association between elevated PTFV1 and an increased risk of stroke recurrence (HR: 2.50; 95% CI: 1.53-4.09; p < 0.01) as well as mortality (HR: 3.76; 95% CI: 1.58-8.91; p < 0.01) at 1 year in patients with ESUS. Furthermore, we observed that moderate-severe LA enlargement slightly increased the risk of stroke recurrence in patients with ESUS (HR: 1.95; 95% CI: 0.90-4.26; p = 0.09). Both LA diameter (HR: 1.03; 95% CI: 1.00-1.06; p = 0.03) and the top quartile of the LA diameter index (HR: 1.56; 95% CI: 1.03-2.40; p = 0.04) were associated with stroke recurrence in patients with ESUS.
Conclusions:
PTFV1 was independently associated with an elevated risk of stroke recurrence and mortality in ESUS patients. Additionally, a trend toward a correlation between LA enlargement and high stroke recurrence risk after ESUS was observed.
