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Atrial Cardiopathy Worsens Neurological Severity, Raises Recurrence Rates, and Leads to Poor Vascular Outcomes in

Sung Hun Kim1, Hyung Jun Kim1, Hyun Kyung Kim1

  • 1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Journal of Stroke
|October 14, 2025
PubMed

Insights

Atrial cardiopathy (AC) significantly increases stroke recurrence and major adverse cardiovascular events (MACEs) in patients with embolic stroke of undetermined source (ESUS). Stratifying patients by AC factors is crucial for managing ESUS and improving outcomes.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Atrial cardiopathy (AC) is a recognized factor in embolic stroke of undetermined source (ESUS).
  • Understanding AC's role in ESUS is vital for predicting patient outcomes.
  • Real-world data is needed to confirm AC's impact on ESUS severity and recurrence.

Purpose of the Study:

  • To investigate the prevalence and clinical significance of atrial cardiopathy (AC) in patients with embolic stroke of undetermined source (ESUS).
  • To assess the impact of AC on stroke severity, recurrence, and major adverse cardiovascular events (MACEs) in ESUS patients.
  • To evaluate the utility of AC stratification in managing ESUS.

Main Methods:

  • Analysis of a South Korean stroke registry (2014-2019) including patients with acute ESUS.
  • AC defined by left atrial enlargement or elevated NT-proBNP levels.
  • Survival analysis in original and propensity score-matched cohorts to determine AC's impact on vascular outcomes.

Main Results:

  • 45.0% of ESUS patients met AC criteria, with 4.7% having multiple AC factors (AC group 2).
  • AC presence and AC group 2 were associated with significantly increased stroke recurrence after propensity score matching.
  • AC group 2 also showed increased MACEs, longer hospital stays, and higher stroke severity.

Conclusions:

  • Atrial cardiopathy, particularly with multiple contributing factors, is linked to adverse clinical outcomes in ESUS patients.
  • AC stratification is essential for effective management and risk assessment in ESUS.
  • Further research should explore targeted therapies for AC in ESUS.
Abstract

Keywords:
Atrial cardiopathyAtrial remodelingCardiomyopathiesCardiovascular diseasesIschemic strokeMajor adverse cardiovascular event

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