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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Prognostic Significance of Atrial Cardiopathy in Patients with Embolic Stroke of an Undetermined Source

Yuan Chai1, Lulu Pei1, Lu Zhao1

  • 1Department of Neurology, the First Affiliated Hospital of Zhengzhou University.

Journal of Atherosclerosis and Thrombosis
|June 28, 2026
PubMed

Insights

Atrial cardiomyopathy (AC) independently predicts recurrent stroke in patients with embolic stroke of an undetermined source (ESUS). Identifying AC improves risk stratification for these patients.

Area of Science:

  • Cardiology
  • Neurology
  • Biomarkers

Background:

  • Atrial cardiomyopathy (AC) is linked to cardiovascular events.
  • The role of anticoagulation in embolic stroke of undetermined source (ESUS) is not fully understood.
  • Prognostic value of AC in ESUS patients needs prospective evaluation.

Purpose of the Study:

  • To prospectively assess the prognostic significance of atrial cardiomyopathy (AC) in patients with embolic stroke of undetermined source (ESUS).
  • To determine if AC improves risk stratification for recurrent ischemic events and mortality in ESUS patients.

Main Methods:

  • Prospective enrollment of 345 ESUS patients within 7 days of symptom onset.
  • AC defined by NT-proBNP levels, P-wave terminal force in V1, or left atrial enlargement.
  • Recurrence evaluated using Fine-Gray models; mortality assessed with Cox models.

Main Results:

  • 42% of ESUS patients had AC.
  • AC was strongly associated with recurrent ischemic stroke/TIA (aSHR 3.36, P<0.001).
  • AC predicted all-cause mortality (aHR 3.80, P=0.024) and improved risk models (NRI, IDI).

Conclusions:

  • Atrial cardiomyopathy is an independent predictor of recurrent ischemic stroke/TIA in ESUS.
  • AC enhances risk stratification for ESUS patients.
  • The association of AC with mortality in ESUS warrants further investigation due to limited events.
Abstract

Keywords:
Atrial cardiomyopathyESUSMortalityPrognosisStroke recurrence

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