Background Atrial cardiomyopathy(AC)is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation(AF).A definition based on the presence of electrical abnormality(P-w...Background Atrial cardiomyopathy(AC)is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation(AF).A definition based on the presence of electrical abnormality(P-wave terminal force in lead V1(PTFV1)>5000µV×ms),N-Terminal pro-B-type natriuretic peptide(NT pro BNP)>250pg/mL and/or indexed left atrial diameter(LADI)>3cm/m^(2)is currently tested in the ARCADIA(AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke)trial.We set out to estimate the prevalence of AC as defined in the ARCADIA trial,its determinants and its association with AF detected after stroke(AFDAS).Methods Stepwise screening for silent Atrial Fibrillation After Stroke(SAFAS)study prospectively included 240 ischaemic stroke patients.AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.Results A total of 183 patients were analysed,of whom 57%(104 patients)met the AC criteria(79 NT-proBNP,47 PTFV1,4 LADI).In the multivariate logistic regression,C reactive protein>3mg/L(OR(95%CI)2.60(1.30 to 5.21),p=0.007)and age(OR(95%CI)1.07(1.04 to 1.10),p<0.001)were found to be independently associated with AC.After 6 months of follow-up,AFDAS was detected in 33%of AC patients and in 14%of the remaining ones(p=0.003).However,AC was not independently associated with AFDAS,contrary to left atrial volume index(>34mL/m^(2),OR 2.35(CI 1.09 to 5.06)p=0029).Conclusion AC as defined in ARCADIA is mostly based on NT pro BNP elevation(76%of patients)and is associated with age and inflammation.Moreover,AC was not independently associated with AFDAS at follow-up.The ARCADIA trial,which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must,therefore be analysed in the light of these limitations.展开更多
文摘Background Atrial cardiomyopathy(AC)is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation(AF).A definition based on the presence of electrical abnormality(P-wave terminal force in lead V1(PTFV1)>5000µV×ms),N-Terminal pro-B-type natriuretic peptide(NT pro BNP)>250pg/mL and/or indexed left atrial diameter(LADI)>3cm/m^(2)is currently tested in the ARCADIA(AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke)trial.We set out to estimate the prevalence of AC as defined in the ARCADIA trial,its determinants and its association with AF detected after stroke(AFDAS).Methods Stepwise screening for silent Atrial Fibrillation After Stroke(SAFAS)study prospectively included 240 ischaemic stroke patients.AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.Results A total of 183 patients were analysed,of whom 57%(104 patients)met the AC criteria(79 NT-proBNP,47 PTFV1,4 LADI).In the multivariate logistic regression,C reactive protein>3mg/L(OR(95%CI)2.60(1.30 to 5.21),p=0.007)and age(OR(95%CI)1.07(1.04 to 1.10),p<0.001)were found to be independently associated with AC.After 6 months of follow-up,AFDAS was detected in 33%of AC patients and in 14%of the remaining ones(p=0.003).However,AC was not independently associated with AFDAS,contrary to left atrial volume index(>34mL/m^(2),OR 2.35(CI 1.09 to 5.06)p=0029).Conclusion AC as defined in ARCADIA is mostly based on NT pro BNP elevation(76%of patients)and is associated with age and inflammation.Moreover,AC was not independently associated with AFDAS at follow-up.The ARCADIA trial,which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must,therefore be analysed in the light of these limitations.
