title: Atrial Cardiopathy and Cryptogenic Stroke: A Cross-sectional Pilot Study.
abstract: BACKGROUND
  There is increasing evidence that left atrial dysfunction or cardiopathy is associated with ischemic stroke risk independently of atrial fibrillation. We aimed to determine the prevalence of atrial cardiopathy biomarkers in patients with cryptogenic stroke.
  
  
  METHODS
  We included consecutive patients with ischemic stroke enrolled in the New York Columbia Collaborative Specialized Program of Translational Research in Acute Stroke registry between December 1, 2008, and April 30, 2012. Medical records were reviewed and patients with a diagnosis of cryptogenic stroke were identified. Atrial cardiopathy was defined as at least one of the following: serum N-terminal probrain natriuretic peptide (NT-proBNP) level greater than 250 pg/mL, P-wave terminal force velocity in lead V1 (PTFV1) on electrocardiogram (ECG) greater than 5000 µV⋅ms, or severe left atrial enlargement (LAE) on echocardiogram. We compared clinical, echocardiographic, and radiological characteristics between patients with and without atrial cardiopathy.
  
  
  RESULTS
  Among 40 patients with cryptogenic stroke, 63% had at least one of the biomarkers of atrial cardiopathy; 49% had elevated NT-proBNP levels, 20% had evidence of increased PTFV1 on ECG, and 5% had severe LAE. Patients with atrial cardiopathy were more likely to be older (76 versus 62 years, P = .012); have hypertension (96% versus 33%, P < .001), hyperlipidemia (60% versus 27%, P = .05), or coronary heart disease (28% versus 0%, P = .033); and less likely to have a patent foramen ovale (4% versus 40%, P = .007).
  
  
  CONCLUSIONS
  There is a high prevalence of biomarkers indicative of atrial cardiopathy in patients with cryptogenic stroke. Clinical trials are needed to determine whether these patients may benefit from anticoagulation to prevent stroke.
authors.affiliation: Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hazan
authors.affiliation: Department of Pathology and Cell Biology, Columbia University, New York, New York.
authors.forename: Eldad A
authors.initials: EA
authors.lastname: Hod
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Alberto
authors.initials: A
authors.lastname: Canaan
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Howard F
authors.initials: HF
authors.lastname: Andrews
authors.affiliation: Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D016279:Atrial Function, Left / Q000502:physiology*; D015415:Biomarkers; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology*; D006332:Cardiomegaly / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000453:epidemiology; D006331:Heart Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012907:Smoking / Q000453:epidemiology; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Stroke; anticoagulant; atrial cardiopathy; cryptogenic; prevention