Importance of atrial cardiomyopathy in patients with embolic stroke of unknown cause and its prognostic significance

Background

In the European Union, several hundred thousand patients suffer from embolic stroke of undetermined source (ESUS) every year. The significance of atrial cardiomyopathy (AtCM) in these patients is uncertain.

Methoden: In this prospective AtCM study, patients with ESUS, AtCM (atrial fibrillation) and cardiac healthy individuals were analysed by means of laboratory, ECG and echocardiography. The patient groups were matched according to age and gender. Inclusion criteria were sinus rhythm at the time of the study. Exclusion criteria included: severe valve stenosis or regurgitation, recent cardioversion, antiarrhythmic therapy, previous pulmonary vein isolation or cardiac surgery. The combined endpoint consisted of death and stroke. All patients with at least 1 year of follow-up were included in this preliminary analysis.

Results

A total of 267 patients (ESUS, n = 84; AtCM, n = 79; Controls, n = 104) were followed up for a mean period of 426 ± 202 days. During the first year, 11 patients in the ESUS group suffered the endpoint (death, n = 1; stroke, n = 10) and 4 patients in the AtCM group (death, n = 4). The event rates differed significantly between the groups over the entire study period (Figure). Independent predictors for the combined endpoint in the overall cohort were: NT-pro-BNP > 420 pg/ml (HR 7.344; CI 2.338-23.066; p < 0.001), advanced interatrial block (HR 3.259; CI 1.147-9.260; p = 0.027) and LAD maximal ≥ 40 mm (HR 2.776; CI 1.093-7.048; p = 0.032).

Conclusion

This preliminary analysis demonstrates a high event rate in patients with ESUS. Compared to the control group, the ESUS group exhibits alterations in left atrial electrical activity and hemodynamics that are similar to those seen in the AtCM group. Our study suggests that parameters of atrial cardiomyopathy have prognostic significance.TableFigure