https://doi.org/10.1007/s00392-025-02625-4
1Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 2Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland; 3Kath. Klinikum Bochum Neurologie Bochum, Deutschland; 4Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland
Background: In recent years, increasing evidence has linked atrial cardiomyopathy (AtCM) to stroke independently of atrial fibrillation (AF). To date, however, definitive cut-off values for AtCM that would warrant treatment are still lacking. In the past, four prospective, randomized studies have failed to demonstrate a benefit of oral anticoagulation in patients with ESUS. The current study was designed to compare the prevalence of markers of AtCM on ECG and echocardiography in patients with ESUS with cardiac healthy individuals, and patients with AF (clinically manifest AtCM).
Methods: Consecutive patients with ESUS without persistent foramen ovale (PFO) were prospectively enrolled. Age- and sex-matched cardiac healthy individuals served as controls, along with patients with spontaneous conversion from AF to sinus rhythm (clinically manifest AtCM). All participants were in sinus rhythm at the time of inclusion. Exclusion criteria were electrical cardioversion within the past three months, treatment with antiarrhythmic drugs, previous pulmonary vein isolation or cardiac surgery. Markers of AtCM were defined as P-wave terminal force (PTFV1) < -4000 (µV*ms), advanced inter-atrial block (IAB), left atrial diameter ≥ 46 mm and left atrial volume index (LAVI) ≥ 50 ml/m2, left atrial ejection fraction (LAEF) < 35%, PA-TDI interval > 150 ms and left atrial strain rate ≤ 20%.
Results: The differences between the three groups are presented in Tables 1-3. Figure 1 presents the prevalence of the different AtCM markers. Several markers differ in frequency between the patients with ESUS and the healthy controls, but not between the patients with ESUS and those with AF. Notably, some patients with AF also had no markers of AtCM.
Conclusion: Patients with ESUS have altered left atrial hemodynamics suggesting AtCM as an underlying disease. Several parameters from ECG and echocardiography appear promising for the diagnosis of AtCM. The parameters of advanced IAB, LAEF and left atrial strain rate (possibly also in combination) may be suitable for future studies to discriminate which patients with ESUS benefit from oral anticoagulation.