Key result
COAST study uses CMR to assess LA fibrosis in recent ischemic stroke patients versus controls.
Why the study?
About 25% of ischaemic strokes remain unexplained, and emerging evidence suggests left atrial functional and structural abnormalities (atrial cardiomyopathy) may convey stroke risk beyond detected atrial fibrillation.
Does the extent of CMR-assessed atrial fibrosis differ between patients with stroke of undetermined aetiology, stroke of known mechanism, and healthy controls?
Cohort (n=150)
Does the extent of CMR-assessed atrial fibrosis differ between patients with stroke of undetermined aetiology, stroke of known mechanism, and healthy controls?
The COAST study protocol aims to use CMR to evaluate the role of atrial cardiomyopathy and left atrial fibrosis in patients with ischaemic stroke of undetermined aetiology.
May support hypothesis that atrial fibrosis contributes to embolic stroke of undetermined source; leaves open whether CMR assessment should guide therapy.
INTRODUCTION: Despite workup for the aetiology of ischaemic stroke, about 25% of cases remain unexplained. Paroxysmal atrial fibrillation is typically suspected but often not detected. Even if atrial fibrillation (AF) is detected, the quantitative threshold of clinically relevant AF remains unclear. Emerging evidence suggests that left atrial (LA) functional and structural abnormalities may convey a risk of ischaemic stroke in which AF is only one of several features. These abnormalities have been termed 'atrial cardiomyopathy'. This study uses cardiac magnetic resonance (CMR) to evaluate atrial cardiomyopathy among patients with stroke of undetermined aetiology compared with those with an attributable mechanism and controls without established cardiovascular disease. METHODS AND ANALYSIS: This cross-sectional and prospective cohort study included 100 patients with recent ischaemic stroke and 50 controls with no established cardiovascular disease. The study will assess LA structural and functional abnormalities with CMR. Inclusion began in March 2019, and follow-up is planned to be complete in January 2023. There are two scheduled follow-ups: (1) 18 months after individual inclusion, counting from the index diagnostic MRI of the brain, (2) end of study follow-up at 18 months after inclusion of the last patient, assessing the incidence of recurrent ischaemic stroke, AF and cardiovascular death. The primary endpoint is the extent of CMR-assessed atrial fibrosis in the LA at baseline. The study is powered to detect a difference of 6% fibrosis between stroke of undetermined aetiology and stroke of known mechanism with a SD of 9%, a significance level of 0.05, and power of 80%. ETHICS AND DISSEMINATION: This study has been approved by the Danish National Committee on Health Research Ethics (H-18055313). All participants in the study signed informed consent. Results from the study will be published in peer-reviewed journals regardless of the outcome. TRIAL REGISTRATION NUMBER: NCT03830983.
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Larsen et al. (2022) conducted a cohort in Ischaemic stroke (n=150). Cardiac magnetic resonance (CMR) vs. Stroke of known mechanism and controls without cardiovascular disease was evaluated on Extent of CMR-assessed atrial fibrosis in the left atrium at baseline. The COAST study will use cardiac magnetic resonance to evaluate left atrial fibrosis in 100 patients with recent ischemic stroke and 50 controls, with follow-up at 18 months.
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