Prevalence of markers of atrial cardiomyopathy in embolic stroke of undetermined source: A systematic review

Stalikas, Nikolaos; Doundoulakis, Ioannis; Karagiannidis, Efstratios; Κάρτας, Αναστάσιος; Gavriilaki, Maria; Sofidis, Georgios; Panteris, Eleftherios; Papazoglou, Αndreas S.; Haidich, Anna‐Bettina; Sianos, Georgios; Giannakoulas, George

doi:10.1016/j.ejim.2022.01.024

Cited by 20 publications

(28 citation statements)

References 44 publications

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“…The main difference between the present study and previous studies is that BNP value was not associated with ICVE in AMI patients. Our results are in line with the previous studies ( 17 ). One possible reason for the lack of such association is that hemodynamics was not stable during AMI and BNP levels are vulnerable to hemodynamic changes.…”

Section: Discussionsupporting

confidence: 94%

“…This is consistent with transesophageal echocardiographic data which suggest that LAE was an independent risk factor for left atrial thrombus or spontaneous echocardiographic contrast and embolic events ( 31 ). Moreover, our study consolidated the relationship between the LAE and ICVE in AMI patients, and LAE may also represent a potential indication either for initiating or monitoring anticoagulant therapy for the prevention of stroke before the onset of AF in patients with AMI ( 17 ).…”

Section: Discussionmentioning

confidence: 53%

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Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

Wang

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundContemporary data on atrial cardiomyopathy (ACM) markers and ischemic cerebrovascular events (ICVE) in patients with acute myocardial infarction (AMI) is lacking. We aimed to examine whether ACM markers predict ICVE among AMI patients.Materials and methodsA total of 4,206 AMI cases diagnosed in clinical examinations between January 2016 and June 2021 were assessed for markers of ACM including B-type natriuretic peptide (BNP), P-wave terminal force in ECG lead V1 (PTFV1), and left atrium diameter (LAD). Left atrial enlargement (LAE) and abnormal PTFV1 were defined by previously published cut-off points. The primary outcome was incident ICVE composed of ischemic stroke (IS) and transient ischemic attack (TIA). Receiver operating curve analyses were used to compare the predictive performance of the CHA2DS2-VASc score combined with ACM markers to the CHA2DS2-VASc score alone.ResultsDuring a median follow-up of 44.0 months, 229 (5.44%) ICVE occurred. Of these, 156 individuals developed IS and the remaining 73 cases were diagnosed with TIAs. The ICVE group showed larger PTFV1 and increased LAD as well as elevated BNP levels at baseline. In the multivariate analysis, we found significant associations with ICVE for PTFV1 (HR per 1,000 μV*ms, 1.143; 95% CI, 1.093–1.196), LAD (HR per millimeter, 1.148; 95% CI, 1.107–1.190), but not BNP after adjusting for known ICVE risk factors and interim atrial fibrillation (AF). The addition of abnormal PTFV1 and LAE improved the predictive accuracy of the CHA2DS2-VASc score with C-statistic increasing from 0.708 to 0.761 (p < 0.001).ConclusionAtrial cardiomyopathy markers including PTFV1 and LAD were associated with incident ICVE independent of well-established risk factors and AF occurrence. The addition of ACM markers with CHA2DS2-VASc score may well discriminate individuals at high risk of ICVE in AMI patients.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 53%

Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

Wang

Liu

et al. 2022

Front. Cardiovasc. Med.

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“…Therefore, early recognition of subclinical atrial disease/atrial cardiomyopathy by any modality such as ECG, cardiac imaging, or biomarkers offers a window of opportunity for lifestyle changes, risk factor control, and potential antifibrotic therapies to prevent the progression to overt clinical atrial disease (22). Currently, a universal criterion for diagnosis of atrial cardiomyopathy is lacking, however, PWIs used in the current study are well-known markers of atrial remodeling/atrial cardiomyopathy and predicted risk of stroke independent of AF (23)(24)(25)(26). Our findings of the association of these ECG markers with HF independent of AF in a multiethnic cohort free of CVD suggest the need to use these markers for risk stratification in high-risk populations with existing cardiometabolic risk factors.…”

Section: Discussionmentioning

confidence: 93%

Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort

Ahmad

Mujtaba

Floyd

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe association of electrocardiographic (ECG) markers of atrial cardiomyopathy with heart failure (HF) and its subtypes is unclear.MethodsThis analysis included 6,754 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. Five ECG markers of atrial cardiomyopathy (P-wave terminal force in V1 [PTFV1], deep-terminal negativity in V1 [DTNV1], P-wave duration [PWD], P-wave axis [PWA], advanced intra-atrial block [aIAB]) were derived from digitally recorded electrocardiograms. Incident HF events through 2018 were centrally adjudicated. An ejection fraction (EF) of 50% at the time of HF was used to classify HF as HF with reduced EF (HFrEF), HF with preserved EF (HFpEF), or unclassified HF. Cox proportional hazard models were used to examine the associations of markers of atrial cardiomyopathy with HF. The Lunn-McNeil method was used to compare the associations in HFrEF vs. HFpEF.Results413 HF events occurred over a median follow-up of 16 years. In adjusted models, abnormal PTFV1 (HR (95%CI): 1.56(1.15–2.13), abnormal PWA (HR (95%CI):1.60(1.16–2.22), aIAB (HR (95%CI):2.62(1.47–4.69), DTNPV1 (HR (95%CI): 2.99(1.63–7.33), and abnormal PWD (HR (95%CI): 1.33(1.02–1.73), were associated with increased HF risk. These associations persisted after further adjustments for intercurrent AF events. No significant differences in the strength of association of each ECG predictor with HFrEF and HFpEF were noted.ConclusionsAtrial cardiomyopathy defined by ECG markers is associated with HF, with no differences in the strength of association between HFrEF and HFpEF. Markers of atrial Cardiomyopathy may help identify individuals at risk of developing HF.

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“…Current evidence highlights the role of LA in ischemic strokes and recently it was used to differentiate stroke subtypes since patients with ESUS had larger LA and higher PTFV1 comparing with patients with non-cardioembolic strokes [ 31 , 32 ]. In our study, a comparation between young ESUS and healthy controls was performed and, except for P-wave dispersion which was higher in cases, LA dimensions and atrium myocardial deformation analysis did not show significant differences between cases and controls.…”

Section: Discussionmentioning

confidence: 99%

Atrial cardiopathy in young adults with embolic stroke of undetermined source: a myocardial deformation imaging analysis

Pires

Silva

Garcia

et al. 2022

Int J Cardiovasc Imaging

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Background Atrial cardiopathy (AC) has emerged as a potential pathological thrombogenic atrial substract of embolic stroke of undetermined source (ESUS), even in the absence of atrial fibrillation. Left atrium (LA) myocardial deformation analysis may be of value as a subclinical marker of AC and a predictor of ESUS. Aims To compare LA mechanical function between ESUS cases and age and sex-matched controls. Methods A single-center analytical study with case-control design was performed. Case group was composed by young patients admitted in the Neurology department from January 2017 to June 2021. Control group was composed by age and sex matched controls recruited from the community. All participants performed echocardiogram and a smaller sample underwent cardiac magnetic resonance. Results We recruited 31 ESUS patients aged between 18 and 65 years and 31 age and sex matched controls. ESUS patients had a significantly higher prevalence of cardiovascular risk factors and patent foramen ovale (PFO). The prevalence of AC was not different between groups. Echocardiogram parameters, including strain analysis, were similar between groups, except for LA appendage (LAA) ostium variation which was significantly lower in ESUS patients (absolute: 6.5vs8.7mm, p<0.001; relative: 44.5%vs53.4%, p=0.002). After exclusion of patients with PFO, all the results were statistically similar. Regarding cardiac magnetic resonance analysis, there were no statistically significant differences between groups. Conclusion This study shows that in our population atria cardiopathy and atrial function was not associated with ESUS.LAA structural and functional abnormalities may play a major role. The role of LAA in ESUS warrants further studies.

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Prevalence of markers of atrial cardiomyopathy in embolic stroke of undetermined source: A systematic review

Cited by 20 publications

References 44 publications

Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort

Atrial cardiopathy in young adults with embolic stroke of undetermined source: a myocardial deformation imaging analysis

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