Abstract 64: Biomarkers of Atrial Cardiopathy and Outcomes After Cryptogenic Stroke: The ARCADIA Trial

Abstract

Background: Atrial cardiopathy is associated with incident ischemic stroke in the absence of clinical atrial fibrillation in prospective cohorts. Whether biomarkers of atrial cardiopathy predict recurrent stroke is less clear. Methods: In the ARCADIA trial, a multicenter randomized trial of apixaban versus aspirin in patients with cryptogenic stroke and evidence of atrial cardiopathy, we explored whether the biomarkers P-wave terminal force in ECG lead V 1 (PTFV1), N-terminal pro-Brain natriuretic peptide (NT-proBNP), or left atrial diameter index (LADI) predicted primary and secondary trial outcomes: (1) recurrent stroke of any type; (2) recurrent ischemic stroke or systemic embolism; and (3) recurrent stroke of any type or death. We analyzed the full cohort using Cox proportional hazard models , sequentially adjusting for treatment effect, demographic factors, and clinical risk factors. NT-proBNP concentrations were log-transformed. Results: With 1,015 of the target 1,100 participants enrolled (mean age 68 years, 54.3% female, 21.1% Black, and 8.1% Hispanic) and mean follow-up of 1.8 years, the trial was stopped for futility. Recurrent stroke occurred in 80 patients (annualized rate, 4.4%) and death in 54 patients. NT-proBNP significantly predicted recurrent stroke; recurrent ischemic stroke or systemic embolism; and recurrent stroke or death after adjusting for other risk factors, while PTFV1 and LADI did not (Table). NT-proBNP predicted recurrent stroke and death most strongly and with little change after adjusting for other risk factors. Treatment effect was not significant in any of the models. Conclusions: In this population of patients with cryptogenic stroke and evidence of atrial cardiopathy, NT-proBNP is a predictor of recurrent stroke and, with greater magnitude, of a composite of stroke or death. The role of NT-proBNP measurement in management after stroke deserves further study.