Why the study?
LA cardiac disease is a suspected cause of ESUS, prompting testing of whether LA fibrosis quantified by LGE-MRI predicts recurrent stroke or AF in ESUS patients.
Does left atrial fibrosis quantified by LGE-MRI predict recurrent stroke or incident atrial fibrillation in patients with embolic stroke of undetermined source (ESUS)?
Population
203 participants across three centers, including healthy controls, lacunar stroke, ESUS, and AF patients
Comparison
Atrial fibrosis across groups, and fibrosis ≥12% vs <12% in ESUS patients
Design
Multicenter prospective cohort study
Follow-up
Mean 19 months
Key result
In patients with ESUS, atrial fibrosis ≥12% was associated with a higher rate of recurrent ischemic stroke or incident atrial fibrillation compared to fibrosis <12% (25.0% vs. 4.8%; p=0.039).
Authors
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May support LGE-MRI fibrosis assessment for ESUS risk stratification; hypothesis-generating and requires prospective validation before practice change.
Cohort (n=203)
Yes
Does left atrial fibrosis quantified by LGE-MRI predict recurrent stroke or incident atrial fibrillation in patients with embolic stroke of undetermined source (ESUS)?
Absolute Event Rate: 25% vs 4.8%
p-value: p=0.039
Left atrial fibrosis ≥12% identified by LGE-MRI in patients with embolic stroke of undetermined source is associated with a significantly higher risk of recurrent stroke or incident atrial fibrillation.
Kühnlein et al. (2021) conducted a cohort in Embolic stroke of undetermined source (ESUS) (n=203). Atrial fibrosis ≥12% vs. Atrial fibrosis <12% was evaluated on Recurrent ischemic stroke, incident AF, or both (p=0.039). In patients with ESUS, atrial fibrosis ≥12% was associated with a higher rate of recurrent ischemic stroke or incident atrial fibrillation compared to fibrosis <12% (25.0% vs. 4.8%; p=0.039).