Abstract
ObjectiveTo compare the proportion of atrial cardiopathy in patients with embolic stroke of undetermined source (ESUS) and other non-cardiac strokes, and to evaluate the prognostic value of atrial cardiopathy biomarkers in patients with ESUS.MethodsThis retrospective study enrolled patients with ischemic stroke from January 2018 to April 2020 in a single stroke center, and compared the proportion of atrial cardiopathy in (1) ESUS group, (2) large artery atherosclerosis (LAA) group, and (3) small-vessel occlusion (SVO) group. Then, it compared the baseline characteristics between ESUS patients with atrial cardiopathy and cardioembolism (CE) group. In addition, the relationship was compared between the biomarkers of atrial cardiopathy and prognosis in patients with ESUS.ResultsIn total, 316 patients with ischemic stroke were included that included 105 (33.23%) ESUS, 84 (26.58%) LAA, 73 (23.10%) SVO, and 54 (17.09%) CE. Among these patients, patients with ESUS were younger, and had lower triglyceride, lower low-density lipoprotein than non-ESUS group. The proportion of atrial cardiopathy in ESUS group was higher than LAA group or SVO group (42.86 vs. 17.86 vs. 8.22%, p < 0.001). Compared with non-atrial cardiopathy group, patients with atrial cardiopathy were older, had lower EF value, larger left ventricular diameter, and longer PR interval. Among 105 patients with ESUS, 11 (10.78%) cases died, 32 (31.37%) cases had poor functional outcome (mRS >2). In the multivariable model, the risk factor associated with the death risk of patients with ESUS was N-terminal pro-B-type natriuretic peptide (NT-proBNP) >250 pg/ml [p = 0.025, hazard ratio (HR) = 4.626, 95% CI: 1.212–17.652] after a 1-year follow-up.ConclusionsAtrial cardiopathy is more common in patients with ESUS, and the characteristics of ESUS patients with atrial cardiopathy are similar to those in patients with CE. NT-proBNP >250 pg/ml is related to the risk of death in patients with ESUS.
Highlights
30% ischemic strokes (ISs) have no identifiable causes even after standard diagnostic evaluation, are defined as cryptogenic stroke (CS) [1]
Patients with the conformation of new stroke onset through diffusion weighted image (DWI) and adequate clinical evaluation as follows were included: brain CT angiography (CTA) and/or magnetic resonance angiography (MRA) and/or digital subtraction angiography (DSA), ultrasound of cervical vessels, 12-lead ECG, echocardiography, dynamic ECG, and NTproBNP
This study collected 1,220 cases of IS from January 2018 to the April 2020, and 316 cases met the criteria of admission and exclusion, among which 105 cases met the criteria for embolic stroke of undetermined source (ESUS) diagnosis
Summary
30% ischemic strokes (ISs) have no identifiable causes even after standard diagnostic evaluation, are defined as cryptogenic stroke (CS) [1]. Accumulating data suggested that atrial cardiopathy, a pathophysiological concept to describe the abnormal atrial substrate or functions, such as atrial fibrosis, impaired myocyte function, and chamber dilation [4–8], possibly form embolic nidus even without atrial fibrillation (AF). There is an association between atrial cardiopathy biomarkers and occurrence of stroke, such as increased p-wave terminal force V1 (PTFV1) [9] on the electrocardiography (ECG), left atrial enlargement [10, 11], increased N-terminal pro-B-type natriuretic peptide (NTproBNP) [12] in serum. They assumed that atrial cardiopathy, indicating abnormal atrial structure and function, might increase stroke risk and this happens even before AF occurs
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