Biomarkers of atrial cardiopathy and embolic stroke of undetermined source

Research indicates that a pathological atrial substrate can cause embolic stroke even in patients without atrial fibrillation (AF). This condition is called atrial cardiopathy - (AC) and it indicates changes in the heart's atria that can precede AF. Subclinical (asymptomatic) AF can be detected in 30% of patients with Embolic Stroke of Undetermined Source (ESUS). The objective of this narrative review is to provide, based on the current literature review, data on the pathogenesis and markers of AC as well as therapeutic possibilities in case of detection of AC in order to prevent an embolic event. AC as a pathological substrate before the development of manifest AF may be a potential mechanism of ESUS. Evaluation of AC biomarkers: p terminal force V1 (PTFV1 >5,000 µVms), N-terminal probrain natriuretic peptid (NT-proBNP >250 pg/ml) and Left atrial enlargement (LAE≥ 3 cm/m2) can be a starting point for ESUS risk identification as well as for timely therapeutic stroke intervention using direct oral anticoagulant therapy (DOAC) in ESUS patients with AC. To conclude, AC biomarkers are useful for monitoring patients with AC who may be at an increased risk for developing ESUS. A detailed and complete etiological assessment to classify patients into the ESUS group and dynamic long-term follow-up of patients to detect subclinical AF are complicating factors for understanding the connection between AC and ESUS. Further research in the area of AC as a risk factor for ESUS is needed since the studies have not proven that AC is an indication for the introduction of DOAC.