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Original research
Atrial cardiopathy and non-stenotic intracranial complicated atherosclerotic plaque in patients with embolic stroke of undetermined source
  1. Lin Tao1,
  2. Ying-Jie Dai1,
  3. Zi-Yang Shang1,
  4. Xiao-Qiu Li1,
  5. Xin-Hong Wang1,
  6. George Ntaios2,
  7. Hui-Sheng Chen1
  1. 1Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
  2. 2Department of Internal Medicine, University of Thessaly, Volos, Greece
  1. Correspondence to Professor Hui-Sheng Chen, Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China; chszh{at}aliyun.com

Abstract

Objective To assess (1) the association between atrial cardiopathy (AC) and non-stenotic intracranial complicated atherosclerotic plaque (NICAP) in patients with embolic stroke of undetermined source (ESUS) or small-vessel disease (SVD), and (2) the performance of previously proposed biomarkers to identify AC as the underlying aetiology in ESUS.

Methods Based on our high-resolution MRI (HR-MRI) cohort, 403 subjects (243 ESUS and 160 SVD) were enrolled in the final analysis. All patients underwent intracranial HR-MRI to assess the presence of ipsilateral NICAP. Biomarkers of AC (ie, P-wave terminal force in lead V1 (PTFV1) on ECG, N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T and left atrial diameter) were collected within 24 hours after admission.

Results Among patients without ipsilateral NICAP, we found an association between the presence of AC (adjusted OR (aOR): 4.76, 95% CI 2.48 to 9.14), increased PTFV1 (aOR: 5.70, 95% CI: 2.43 to 13.39) and NT-proBNP (aOR: 1.65, 95% CI: 1.16 to 2.35) with ESUS. This association was not evident among patients with ipsilateral NICAP. The discrimination between ESUS versus SVD by AC/AC-related biomarkers was significantly improved after excluding ipsilateral NICAP. Similarly, the discrimination between ESUS and SVD by ipsilateral NICAP was notably augmented after excluding AC, PTFV1 and NT-proBNP.

Interpretation AC is more prevalent in patients who had ESUS without ipsilateral NICAP compared with patients with, implying that AC and ipsilateral NICAP are two distinct, competing aetiologies of ESUS. Among the AC biomarkers studied in this analysis, PTFV1 seems to be the most informative.

  • stroke

Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared upon reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared upon reasonable request to the corresponding author.

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Footnotes

  • LT and Y-JD contributed equally.

  • Contributors LT, Y-JD and Z-YS retrospectively enrolled patients, acquired the data and did the literature search. X-HW and X-QL retrospectively enrolled patients and acquired the data. LT wrote the paper. LT and Y-JD did the statistical analysis. LT and Z-YS did the measurement of P-wave terminal force in lead V1 on ECG. GN critically revised the manuscript. H-SC, acting as guarantor, designed the study and critically revised the manuscript.

  • Funding The work was supported by grants from National Key R&D Program of China (2017YFC1308200) and the Science and Technology Project Plan of Liao Ning Province (2018225023 and 2019JH2/10300027).

  • Disclaimer All authors approved the content of the manuscript. The funding agency of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The manuscript and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicity accessible web sites or e-print servers.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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