Symmetric Dimethylarginine for Risk Stratification of Cardioembolic Stroke
Johanna Ernst1, Ilai Mick Albert Darius Kaulbarsch2,3, Svenja L Jochmann2
1Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, Hannover, 30625, Germany. Ernst.johanna@mh-hannover.de.
Translational Stroke Research
|July 14, 2026
Summary
Symmetric dimethylarginine (SDMA) and the L-arginine/SDMA ratio show promise in identifying cardioembolic stroke (CES) and atrial fibrillation after stroke (AFDAS). These biomarkers may aid in secondary stroke prevention strategies.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Biochemistry
Background:
- Embolic stroke of undetermined source (ESUS) poses challenges for secondary stroke prevention.
- Nitric oxide metabolism, involving L-arginine (Arg), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA), is crucial for cardiovascular health.
- Previous research suggests SDMA and Arg/SDMA ratios may help detect atrial fibrillation (AF).
Purpose of the Study:
- To investigate if SDMA and the Arg/SDMA ratio can improve the diagnosis of cardioembolic stroke (CES) compared to ESUS.
- To assess the potential of these biomarkers for more accurate secondary prevention strategies in stroke patients.
Main Methods:
- A prospective nested case-control study involving 235 ischemic stroke patients (107 CES, 128 ESUS) was conducted.
- Blood samples were analyzed for Arg, ADMA, and SDMA concentrations 24 hours post-stroke onset.
- Logistic regression and receiver operating curve analyses were used to evaluate biomarker performance against clinical risk scores.
Main Results:
- The Arg/SDMA ratio and SDMA levels demonstrated discriminatory power between CES and ESUS, comparable or superior to established clinical AF scores (AUC SDMA=0.71, AUC Arg/SDMA=0.74).
- These biomarkers also showed effectiveness in differentiating AF detected after stroke (AFDAS) from ESUS.
- Combining the Arg/SDMA ratio with the AS5F score offered a modest improvement in diagnostic accuracy over AS5F alone.
Conclusions:
- SDMA and the Arg/SDMA ratio can serve as valuable biomarkers for detecting AF and AFDAS in stroke patients.
- While their added predictive value to existing clinical scores may be limited, these findings highlight the Arg/SDMA pathway's role in stroke pathophysiology.
- Further research could explore integrating these biomarkers into clinical practice for improved stroke risk stratification and prevention.
