Key result
Elevated NT-proBNP and left atrial enlargement strongly track with cardioembolic vs. atherothrombotic stroke.
Why the study?
The utility of individual clinical, imaging, and atrial cardiopathy markers in predicting cardioembolic sources among ischemic stroke subtypes requires further study.
Do atrial cardiopathy markers predict cardioembolic sources in patients with ischemic stroke?
Observational (n=255)
No
Do atrial cardiopathy markers predict cardioembolic sources in patients with ischemic stroke?
Elevated NT-pro-BNP and chronic non-lacunar infarcts on imaging can help identify cardioembolic sources in patients with embolic strokes.
Answers are grounded in this paper and cite their sources.
May aid etiology workup in ischemic stroke; leaves open prospective validation before changing practice.
BACKGROUND AND OBJECTIVES: Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE. METHODS: This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes. RESULTS: We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m 2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes. CONCLUSIONS: The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.
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Sreedharan et al. (2025) conducted an observational in Ischemic stroke (n=255). Atrial cardiopathy markers (NT-pro-BNP, LA enlargement) and chronic non-lacunar infarcts vs. Large artery atherosclerosis or cryptogenic stroke was evaluated on Cardioembolic stroke etiology. Elevated NT-pro-BNP (prevalent in 43.95% of patients) and left atrial enlargement were strongly predictive of cardioembolic stroke etiology when compared to large artery atherosclerosis.
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