Key result
Atrial cardiopathy biomarkers are present in ~97% of cardioembolic strokes, nearly doubling prevalence versus ESUS.
Why the study?
Atrial cardiopathy has been proposed as a potential embolic mechanism in embolic stroke of undetermined source, but the distribution of its biomarkers across ischemic stroke subtypes remained unclear.
Cross-Sectional (n=533)
No
Atrial cardiopathy as defined by ARCADIA trial criteria is highly prevalent not only in cardioembolism (97%) and ESUS (54%) but also across non-cardioembolic ischemic stroke subtypes (43%–53%), suggesting current biomarker thresholds lack specificity for causal atrial thromboembolism.
Single ARCADIA biomarker criteria show limited specificity beyond cardioembolism; leaves open whether stricter thresholds or combinations better identify causal atrial dysfunction in ESUS.
Background: Atrial cardiopathy (AC) has been proposed as a potential embolic mechanism in embolic stroke of undetermined source (ESUS); however, the distribution of AC biomarkers across ischemic stroke subtypes remains unclear. Methods: We retrospectively analyzed 533 consecutive patients with acute ischemic stroke. Stroke subtypes were classified as small-vessel occlusion (SVO), branch atheromatous disease (BAD), large-artery atherosclerosis (LAA), ESUS, or cardioembolism (CE). AC was defined according to ARCADIA trial criteria as the presence of at least one of the following: P-wave terminal force in lead V1 (PTFV1) >5,000 μV·ms, N-terminal pro–brain natriuretic peptide (NT-proBNP) >250 pg/mL, or left atrial diameter index (LADI) ≥3 cm/m2. We evaluated the prevalence and overlap of these biomarkers across subtypes. Results: AC biomarkers were significantly more frequent in CE than in other subtypes. Using ≥1 biomarker, AC prevalence was 43% in SVO, 49% in BAD, 53% in LAA, 54% in ESUS, and 97% in CE. With ≥2 biomarkers, prevalence decreased to 8%, 7%, 13%, 19%, and 78%, respectively. NT-proBNP elevation was the most common biomarker across all groups. Left atrial enlargement was rare in non-CE subtypes (~5%) and showed no overlap with PTFV1 in SVO, BAD, or LAA. Conclusions: While AC defined by ARCADIA criteria is highly prevalent in CE, it is also widely observed across other stroke subtypes. Refinement of AC definitions, including stricter thresholds and/or biomarker combinations, may better identify atrial dysfunction with causal relevance to stroke.
No takes yet. Share an insight, caveat, or question.
Kato et al. (2026) conducted a cross-sectional in Acute ischemic stroke (n=533). Cardioembolic stroke subtype vs. Non-cardioembolic stroke subtypes (ESUS, LAA, BAD, SVO) was evaluated on Prevalence of atrial cardiopathy defined by ARCADIA criteria (>=1 biomarker: PTFV1 >5,000 μV·ms, NT-proBNP >250 pg/mL, or LADI >=3 cm/m2) (p=<0.005). Atrial cardiopathy biomarkers were significantly more prevalent in cardioembolic stroke (97%) than in ESUS (54%), LAA (53%), BAD (49%), and SVO (43%) (p<0.005).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: