Cancer and Left Atrial Enlargement in Patients with Ischemic Stroke: Atrial cardiopathy in cancer-related stroke

Abstract

BackgroundCancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain. MethodsWe conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m2 on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS). ResultsThe final cohort included 1104 patients with acute ischemic stroke, of whom 10% had active cancer and 47% had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6% of patients with atrial cardiopathy (n=50/520) and 10.4% of patients without (n=61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95% confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95% CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (n=236, 21.4%), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95% CI, 0.68-1.25). ConclusionsWhen defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.