Key result
Non-invasive atrial cardiomyopathy markers marginally improve stroke lesion discrimination beyond established clinical risk factors.
Why the study?
Emerging evidence suggests atrial cardiomyopathy may contribute to stroke risk independently of AF, but whether non-invasive markers add diagnostic value beyond clinical risk factors for cerebral stroke lesions on MRI was unknown.
Do non-invasive atrial cardiomyopathy markers provide incremental diagnostic value beyond established clinical risk factors for identifying cerebral stroke lesions on MRI in a general population?
Do non-invasive atrial cardiomyopathy markers provide incremental diagnostic value beyond established clinical risk factors for identifying cerebral stroke lesions on MRI in a general population?
Non-invasive markers of atrial cardiomyopathy provide only marginal incremental diagnostic value over established clinical risk factors for identifying cerebral stroke lesions on MRI.
Should not yet change practice beyond established clinical risk factors for cerebral stroke lesions; leaves open the value of refined non-invasive atrial cardiomyopathy markers.
Background and Aims Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke. Emerging evidence suggests that atrial cardiomyopathy (AtCM), independent of AF, may be a key contributor to stroke risk. We aimed to evaluate whether non-invasive AtCM markers assessed by electrocardiography (ECG), transthoracic echocardiography (TTE), and blood-based biomarkers provide incremental diagnostic value beyond established clinical risk factors for identifying cerebral stroke lesions on magnetic resonance imaging (MRI). Methods We analyzed 1,794 Hamburg City Health Study participants who underwent cerebral MRI with available baseline 12-lead ECG and TTE in sinus rhythm. Logistic regression analyses were performed to identify associations between non-invasive AtCM markers and stroke lesions. The incremental discriminatory performance of these markers beyond clinical risk factors was assessed. Results Stroke lesions were present in 152 participants (8.5%). Male sex, history of prior AF and higher CHA₂DS₂-VA score were significantly associated with stroke lesions. Among AtCM markers, amplified P-wave duration, P-wave area in lead II, PR interval, left atrial volume index, left atrial ejection fraction, and NT-proBNP were also significant. Combining both clinical and AtCM markers, only CHA₂DS₂-VA score (OR:1.95 per point, 95%CI:1.49-2.55, p<0.001) and P-wave area in lead II (OR:0.99 per 100µV·ms, 95%CI:0.98-1.00, p=0.031) remained independent predictors. However, this resulted in only marginal improvement in discrimination (ΔAUC:0.03, 95%CI: 0.0001-0.0594) compared with the clinical risk factor model alone. Conclusion The incremental diagnostic value of AtCM markers beyond clinical risk factors for MRI-defined cerebral lesions is limited, likely reflecting the heterogeneous etiology of stroke lesions in a general population cohort.
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Biedermann et al. (2026) studied this question. Non-invasive atrial cardiomyopathy markers provided only marginal improvement in discrimination (ΔAUC: 0.03, 95% CI: 0.0001-0.0594) for stroke lesions beyond clinical risk factors.
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