ArticleJournal of stroke2025
Atrial Cardiopathy Worsens Neurological Severity, Raises Recurrence Rates, and Leads to Poor Vascular Outcomes in Patients With Embolic Stroke of Undetermined Source.
Article in Journal of stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeAtrial cardiopathy (AC) has been studied for its significance in embolic stroke of undetermined source (ESUS). This real-world study examines the relevance of AC in ESUS and its impact on stroke severity, recurrence, and major adverse cardiovascular events (MACEs).
methodsWe analyzed patients from stroke registries of South Korean centers (2014-2019) aged ≥20 years with acute ESUS or cardiogenic stroke without a definite embolic source. AC was defined by left atrial (LA) enlargement (diameter >40 mm in men and >38 mm in women; or LA volume index >34 mL/m2) or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP, ≥250 pg/mL) levels. Patients were classified based on AC presence and stratified by the number of factors (AC groups 0, 1, and 2). Survival analysis in original and propensity score (PS)-matched cohorts assessed the impact of AC on stroke severity and vascular outcomes.
resultsAmong 5,787 patients (65.9±13.9 years; female: 39.8%), 45.0% met the AC criteria (group 1: 40.3%, group 2: 4.7%). In the original cohort, AC group 2 was associated with increased stroke recurrence (hazard ratio [HR]: 1.76, 95% confidence interval [CI]: 1.06-2.92, P=0.03). After PS-matching, stroke recurrence remained significantly increased for AC (HR: 1.37, 95% CI: 1.04-1.79, P=0.02) and group 2 (HR: 1.94, 95% CI: 1.16-3.26, P=0.01). MACE outcomes increased in the group 2 patients (HR: 1.70, 95% CI: 1.07-2.70, P=0.02). NT-proBNP (HR: 0.97, 95% CI: 0.84-1.12, P=0.69) or LA enlargement (HR: 1.15, 95% CI: 0.89-1.49, P=0.28) alone were not predictive. AC correlated with longer hospital stays, and AC stratification with higher severity.
conclusionEspecially with multiple factors, AC was associated with adverse clinical outcome in patients with ESUS. These findings underscore the importance of AC stratification in the management of ESUS patients.
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