Atrial Cardiopathy Worsens Neurological Severity, Raises Recurrence Rates, and Leads to Poor Vascular Outcomes in Patients With Embolic Stroke of Undetermined Source.

IF 11 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Stroke Pub Date : 2025-09-01 Epub Date: 2025-09-29 DOI:10.5853/jos.2025.00906

Sung Hun Kim, Hyung Jun Kim, Hyun Kyung Kim, Jang-Hyun Baek, Hahn Young Kim, Yang-Ha Hwang, Sung Hyuk Heo, Ho Geol Woo, Hyungjong Park, Sung-Il Sohn, Chi Kyung Kim, Jin-Man Jung, Sang-Hun Lee, Jae-Kwan Cha, Hee-Joon Bae, Beom Joon Kim, Bum Joon Kim, Ji Sung Lee, Hyo Suk Nam, Jee-Hyun Kwon, Wook-Ju Kim, Hee-Kwon Park, Man-Seok Park, Kang-Ho Choi, Jay Chol Choi, Joong-Goo Kim, Chul-Hoo Kang, Kwang Yeol Park, Young Seo Kim, Gyeong-Moon Kim, Oh Young Bang, Jong-Won Chung, Sung-A Chang, Tae-Jin Song, Moo-Seok Park, Min Kyoung Kang, Sun Uck Kwon, Woo-Keun Seo

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引用次数: 0

Abstract

Background and purpose: Atrial cardiopathy (AC) has been studied for its significance in embolic stroke of undetermined source (ESUS). This real-world study examines the relevance of AC in ESUS and its impact on stroke severity, recurrence, and major adverse cardiovascular events (MACEs).

Methods: We analyzed patients from stroke registries of South Korean centers (2014-2019) aged ≥20 years with acute ESUS or cardiogenic stroke without a definite embolic source. AC was defined by left atrial (LA) enlargement (diameter >40 mm in men and >38 mm in women; or LA volume index >34 mL/m2) or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP, ≥250 pg/mL) levels. Patients were classified based on AC presence and stratified by the number of factors (AC groups 0, 1, and 2). Survival analysis in original and propensity score (PS)-matched cohorts assessed the impact of AC on stroke severity and vascular outcomes.

Results: Among 5,787 patients (65.9±13.9 years; female: 39.8%), 45.0% met the AC criteria (group 1: 40.3%, group 2: 4.7%). In the original cohort, AC group 2 was associated with increased stroke recurrence (hazard ratio [HR]: 1.76, 95% confidence interval [CI]: 1.06-2.92, P=0.03). After PS-matching, stroke recurrence remained significantly increased for AC (HR: 1.37, 95% CI: 1.04-1.79, P=0.02) and group 2 (HR: 1.94, 95% CI: 1.16-3.26, P=0.01). MACE outcomes increased in the group 2 patients (HR: 1.70, 95% CI: 1.07-2.70, P=0.02). NT-proBNP (HR: 0.97, 95% CI: 0.84-1.12, P=0.69) or LA enlargement (HR: 1.15, 95% CI: 0.89-1.49, P=0.28) alone were not predictive. AC correlated with longer hospital stays, and AC stratification with higher severity.

Conclusion: Especially with multiple factors, AC was associated with adverse clinical outcome in patients with ESUS. These findings underscore the importance of AC stratification in the management of ESUS patients.

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来源不明的栓塞性卒中患者心房心脏病加重神经系统严重程度，增加复发率，并导致血管预后不良。

背景与目的：研究心房心脏病（AC）在不明来源栓塞性卒中（ESUS）中的意义。这项现实世界的研究考察了AC在ESUS中的相关性及其对卒中严重程度、复发和主要不良心血管事件（mace）的影响。方法：我们分析了来自韩国中心卒中登记的患者（2014-2019），年龄≥20岁，急性ESUS或心源性卒中，没有明确的栓塞来源。AC的定义是左心房（LA）增大（男性直径bbb40 mm，女性直径bbb38 mm；或LA体积指数bbb34 mL/m2）或n端前b型利钠肽（NT-proBNP,≥250 pg/mL）水平升高。患者根据AC的存在进行分类，并根据因素数量进行分层（AC组0、1和2）。原始和倾向评分（PS）匹配队列的生存分析评估了AC对卒中严重程度和血管结局的影响。结果：5787例患者（65.9±13.9岁，女性39.8%）中，有45.0%符合AC标准（组1:40.3%，组2:4.7%）。在原始队列中，AC组2与卒中复发率增加相关（风险比[HR]: 1.76, 95%可信区间[CI]: 1.06-2.92， P=0.03）。ps匹配后，AC组（HR: 1.37, 95% CI: 1.04-1.79， P=0.02）和2组（HR: 1.94, 95% CI: 1.16-3.26， P=0.01）卒中复发率仍显著增加。2组患者的MACE结果增加（HR: 1.70, 95% CI: 1.07-2.70， P=0.02）。NT-proBNP （HR: 0.97, 95% CI: 0.84-1.12， P=0.69）或LA扩大（HR: 1.15, 95% CI: 0.89-1.49， P=0.28）单独不具有预测作用。AC与更长的住院时间相关，AC分层与更严重程度相关。结论：特别是在多种因素的影响下，AC与ESUS患者的不良临床结局相关。这些发现强调了AC分层在ESUS患者管理中的重要性。

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.