Background: Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke. Emerging evidence suggests that atrial cardiomyopathy (AtCM), independent of AF, may be a key contributor to stroke risk.
Objective: To evaluate whether non-invasive AtCM markers assessed by electrocardiography (ECG), transthoracic echocardiography (TTE), and blood-based biomarkers add diagnostic value to established clinical risk factors for detecting stroke lesions on cerebral magnetic resonance imaging (MRI).
Methods: This study analyzed 1,794 participants of the Hamburg City Health Study with sinus rhythm who underwent cerebral MRI. Logistic regression analyses were performed to identify associations between non-invasive AtCM markers and stroke lesions. The incremental diagnostic value of these markers beyond clinical risk factors was assessed.
Results: Stroke lesions were present in 152 participants (8.5%). Male sex, AF, and higher CHA₂DS₂-VA score as clinical risk factors were significantly associated with stroke lesions (ROC-AUC 0.70). Among AtCM markers, amplified P-wave duration, P-wave area in lead II, left atrial volume, and NT-proBNP were also significant. Combining both clinical and AtCM markers, only CHA₂DS₂-VA score (odds ratio[OR]:1.94 per point, 95%confidence interval[CI]:1.49-2.52, p<0.001) and P-wave area in lead II (OR:0.99 per 100µV*ms, 95%CI:0.98-1.00, p=0.018) remained independent predictors. However, this resulted in only a minimal improvement in discrimination (ROC-AUC 0.71) compared with the clinical risk factor model alone.
Conclusion: ECG and TTE-derived AtCM markers, alongside clinical risk factors, are significantly associated with cerebral lesions. However, the added diagnostic value of AtCM markers is of limited value possibly due to the heterogeneous etiology of stroke lesions in the general population.
