Prevalence of Atrial Cardiopathy Biomarkers Across Ischemic Stroke Subtypes

29/10/2026

AI Summary

Atrial cardiopathy biomarkers were almost universal in cardioembolism (97%) but also common across other subtypes (43% to 54% with ≥1 biomarker).
NT-proBNP elevation was the most frequent biomarker; left atrial enlargement was rare outside cardioembolism and did not overlap with PTFV1 in non-CE subtypes.
Refinement of AC definitions, via stricter thresholds and biomarker combinations, may better identify atrial dysfunction with causal relevance to ischaemic stroke.

J Nippon Med Sch. 2026;93(5):394-401. doi: 10.1272/jnms.JNMS.2026_93-513.

ABSTRACT

BACKGROUND: Atrial cardiopathy (AC) has been proposed as a potential embolic mechanism in embolic stroke of undetermined source (ESUS); however, the distribution of AC biomarkers across ischemic stroke subtypes remains unclear.

METHODS: We retrospectively analyzed 533 consecutive patients with acute ischemic stroke. Stroke subtypes were classified as small-vessel occlusion (SVO), branch atheromatous disease (BAD), large-artery atherosclerosis (LAA), ESUS, or cardioembolism (CE). AC was defined according to ARCADIA trial criteria as the presence of at least one of the following: P-wave terminal force in lead V1 (PTFV1) >5,000 μV·ms, N-terminal pro-brain natriuretic peptide (NT-proBNP) >250 pg/mL, or left atrial diameter index (LADI) ≥3 cm/m². We evaluated the prevalence and overlap of these biomarkers across subtypes.

RESULTS: AC biomarkers were significantly more frequent in CE than in other subtypes. Using ≥1 biomarker, AC prevalence was 43% in SVO, 49% in BAD, 53% in LAA, 54% in ESUS, and 97% in CE. With ≥2 biomarkers, prevalence decreased to 8%, 7%, 13%, 19%, and 78%, respectively. NT-proBNP elevation was the most common biomarker across all groups. Left atrial enlargement was rare in non-CE subtypes (~5%) and showed no overlap with PTFV1 in SVO, BAD, or LAA.

CONCLUSIONS: While AC defined by ARCADIA criteria is highly prevalent in CE, it is also widely observed across other stroke subtypes. Refinement of AC definitions, including stricter thresholds and/or biomarker combinations, may better identify atrial dysfunction with causal relevance to stroke.

PMID:42951594 | DOI:10.1272/jnms.JNMS.2026_93-513

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