Atrial cardiopathy: a mechanism of cryptogenic stroke

ABSTRACT

Introduction: Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes.

Areas covered: This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial cardiopathy, critically review data on biomarkers of atrial cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research.

Expert commentary: Atrial cardiopathy may constitute one of the mechanisms in cryptogenic stroke, and patients with evidence of atrial cardiopathy constitute a group of patients in whom clinical trials are warranted to test anticoagulation versus antiplatelet therapy to reduce stroke recurrence risk. In addition, more studies are needed to determine the degree of overlap between these atrial cardiopathy biomarkers and which one is more useful in predicting the risk of stroke and response to anticoagulation therapy.

KEYWORDS:

• Atrial fibrillation
• stroke
• atrial disease
• atrial cardiopathy
• atrial dysfunction

Declaration of interest

M.S.V. Elkind receives compensation for providing consultative services for Abbott, Biotelemetry/Cardionet, Boehringer-Ingelheim, and Sanofi-Regeneron Partnership; receives study medication in kind but no personal compensation from the BMS-Pfizer Alliance for a clinical trial of atrial cardiopathy; and receives royalties from UpToDate for chapters related to stroke; and serves on the National, Founders Affiliate, and New York City chapter boards of the American Heart Association/American Stroke Association. M.S.V. Elkind’s institution, Columbia University, receives compensation through a service agreement with Medtronic for M.S.V. Elkind’s effort on clinical trials related to cardiac monitoring. H. Kamel was on a speaker’s bureau for Genentech, regarding alteplase for acute ischemic stroke; is an unpaid consultant for Medtronic and iRhythm, regarding heart-rhythm monitoring after stroke; and is a JAMA Neurology deputy editor. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was funded by a grant from the National Institutes of Health (ID: K23 NS082367).