Key result
Anticoagulants may benefit recurrent ESUS patients with markers of atrial cardiopathy or silent AF.
Why the study?
Atrial cardiopathy and silent AF are potential causes of embolic cryptogenic stroke whose timely diagnosis can alter secondary prevention and reduce recurrent stroke risk.
Does anticoagulant therapy prevent recurrent stroke in patients with embolic cryptogenic stroke and atrial cardiopathy or silent atrial fibrillation?
Does anticoagulant therapy prevent recurrent stroke in patients with embolic cryptogenic stroke and atrial cardiopathy or silent atrial fibrillation?
Anticoagulant therapy may be beneficial for secondary stroke prevention in patients with recurrent ESUS who have structural and functional markers of atrial cardiopathy and high thromboembolic risk.
Atrial cardiopathy (AC) and silent atrial fibrillation (AF) are potential causes of embolic cryptogenic stroke (embolic stroke of undetermined source, ESUS) timely diagnosis of which can significantly change the direction of secondary prevention and reduce the risk of repeated brain catastrophe. The article discusses clinical and radiological markers of cardioembolism, the concept of atrial cardiopathy, its electrocardiographic, echocardiographic and serum markers, as well as the possibility of drug prophylaxis of recurrent stroke. The most applicable AC features in daily operation are the ECG data (p-wave terminal force in lead V1 > 5000 μV x ms, supraventricular extrasystoles and advanced interatrial block), 24-hour ECG monitoring (≥ 480 supraventricular extrasystoles per 24-hour, paroxysms of supraventricular tachycardia ≥ 20 complexes), transthoracic (diameter of left atrium > 40 mm, index of diameter of left atrium ≥ 3 cm/m 2 , index of volume of left atrium > 34 ml/m 2 ) and transesophageal echocardiography (spontaneous echo contrast phenomenon, blood flow rate in LA appendage <20 cm/s) and NT-proBNP concentration > 250 pg/ml. An individual, interdisciplinary decision to prescribe an anticoagulant when combined: (1) the presence of structural and functional AC markers, (2) cardioembolic pattern of a cerebral infarction or intracranial artery occlusion by visualization data and (3) high thromboembolic risk and probability of detection of AF on assessment scales (CHA2DS2-VASc, AF-ESUS and C2HEST). The greatest benefit of prescribing anticoagulant therapy can be obtained by patients with recurrent ESUS in whom sufficient secondary prevention and expressed AC, typical cardioembolism imaging pattern and high risk of thromboembolic events have already been achieved.
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Demin et al. (2022) conducted a review in Cryptogenic stroke (embolic stroke of undetermined source, ESUS), atrial cardiopathy, silent atrial fibrillation. Anticoagulant therapy was evaluated. Atrial cardiopathy and silent atrial fibrillation are potential causes of embolic cryptogenic stroke, and anticoagulant therapy may benefit patients with recurrent ESUS and structural/functional markers.
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