Atrial cardiopathy: a mechanism of cryptogenic stroke

Abstract

Introduction Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes. Areas covered This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial cardiopathy, critically review data on biomarkers of atrial cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research. Expert commentary Atrial cardiopathy may constitute one of the mechanisms in cryptogenic stroke, and patients with evidence of atrial cardiopathy constitute a group of patients in whom clinical trials are warranted to test anticoagulation versus antiplatelet therapy to reduce stroke recurrence risk. In addition, more studies are needed to determine the degree of overlap between these atrial cardiopathy biomarkers and which one is more useful in predicting the risk of stroke and response to anticoagulation therapy.

Paroxysmal supraventricular tachycardia and risk of ischemic stroke: A systematic review and meta‐analysis

“…Elevated heart rate from PSVT can lead to overwork of myocardium which would subsequently lead to depletion of myocardial energy storage, abnormal calcium handling and accumulation of reactive oxygen species . In the event of persistent or frequent recurrent PSVT, this process can eventually lead to apoptosis of myocardial cells and fibrosis, resulting in permanent structural changes of the atria . One of the frequent structural changes seen in patients with atrial cardiomyopathy is left atrial enlargement, which is known to provoke stasis of blood flow and increase the risk of thrombus formation .…”

“…19,20 In the event of persistent or frequent recurrent PSVT, this process can eventually lead to apoptosis of myocardial cells and fibrosis, resulting in permanent structural changes of the atria. 21 One of the frequent structural changes seen in patients with atrial cardiomyopathy is left atrial enlargement, 22,23 which is known to provoke stasis of blood flow and increase the risk of thrombus formation. 24 In addition, atrial fibrosis is associated with poor atrial contractility, [25][26][27] which would further promote stagnation of the flow.…”

Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

“…Current data indicate that a diseased left atrium-recently referred as so called "atrial cardiopathy" [159]-might lead to enhanced thrombembolic risk independently of AF which is regarded as a mere symptom of the disease process [160,161]. Endothelial dysfunction mechanisms and subclinical atherosclerosis are closely related to the development of atrial cardiopathy in terms of a systemic disorder [162][163][164][165][166].…”

Atrial Cardiopathy and Sympatho-Vagal Imbalance in Cryptogenic Stroke: Pathogenic Mechanisms and Effects on Electrocardiographic Markers

“…However the relationship between AF and stroke appears more complex than a simple cause-effect mechanism and it seems that AF, atrial substrate, and systemic factors interact in complex ways in the pathway leading to stroke ( 4 ). In particular, the lack of direct evidence of a causal association and a temporal relationship between AF and thromboembolic stroke in most patients suggested the hypothesis that atrial cardiopathy may underlie most strokes; thus, AF could represent only a marker of atrial dysfunction ( 5 ). Thereby, atrial cardiopathy would represent a continuum, replacing AF as a standalone disease; according to this conceptual model, different races could have different rates of rhythm disorders (AF or atrial flutter) depending on the stage of the atriopathy, with higher risk of stroke at any of these stages ( 6 ).…”