Atrial Cardiopathy in Embolic Strokes of Undetermined Source

Embolic Strokes of Undetermined Source (ESUS) accounts for about 9-25% of all ischemic strokes. Atrial cardiopathy (AC) is a recently described pathology of the left atrium and is found to be associated with embolic strokes. This study aimed to study the prevalence and outcomes of AC among patients with ESUS.

This is a single-centre, prospective, observational study conducted over a period of 1 year. AC was diagnosed by the presence of any one of the following biomarker using electrocardiogram (P-wave duration ≥110 ms, prolonged PR interval ≥200 ms, P-wave terminal force V1 ≥5000 μV*ms), echocardiogram (left atrial diameter ≥39 mm in men and ≥37 mm in women, left atrial volume index ≥34 ml/m2) or serum (N-terminal-probrain natriuretic peptide [NT-proBNP] ≥250 pg/mL) at baseline among patients with ESUS. All the patients were followed up after 90 days. The study cohort was divided into two groups: ESUS with AC and ESUS without AC. Both groups were compared using the Mann-Whitney U test. Fisher's exact test was used to identify the parameter associated with recurrent stroke. P <0.05 was considered statistically significant.

A total of 63 patients were included in the study with a mean age of 59.2 (5.6) years. A total of 48 patients (76%) were included in the ESUS with AC group, and 15 patients (24%) were included in the ESUS without AC group. NT-proBNP was the most common AC biomarker found in 24 (39%) patients, followed by elevated left atrial diameter found in 23 (37%) patients. Recurrent stroke was seen in 11 (18%) patients during 90-days follow-up. Abnormal P-wave terminal force V1 and P-wave duration ≥110 ms were significantly associated with stroke recurrence (P = 0.054).

There is a high prevalence of AC among patients with ESUS, and NT-proBNP >250 pg/mL is the most common biomarker. Abnormal P-wave terminal force in V1 and P-wave duration may be associated with stroke recurrence.