Article Figures & Data
- Figure 1
Flowchart. NT-proBNP, N-Terminal pro-B-type natriuretic peptide; SAFAS, Stepwise screening for silent Atrial Fibrillation After Stroke; ARCIDIA, AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke.
- Figure 2
Distribution of the criteria for atrial cardiomyopathy (AC) according to ARCADIA definition in the SAFAS cohort. 104 patients had at least 1 AC criteria, and these were distributed as shown in the figure below. LADI, left atrial diameter index; NT-proBNP, N-Terminal pro-B-type natriuretic peptide; PTFV1, P-wave terminal force in lead V1; SAFAS, Stepwise screening for silent Atrial Fibrillation After Stroke; ARCIDIA, AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke.
- Table 1
Clinical characteristics of patients (n (%) or median (IQR))
No atrial cardiomyopathy (n=79 (44%)) Atrial cardiomyopathy (n=104 (56%)) P Risk factors Age, years 62.89 (54.94–71.33) 75.21 (64.97–81.87) <0.001 Female sex 31 (39.20) 48 (46.20) 0.350 BMI, kg/m2 26.49 (23.84–29.39) 26.24 (23.13–29.25) 0.500 Obesity (BMI>30 kg/m2) 16 (20.30) 22 (21.20) 0.882 High blood pressure 35 (44.30) 69 (66.30) 0.003 Hypercholesterolaemia 23 (29.10) 34 (32.70) 0.605 Diabetes 23 (29.10) 27 (26.00) 0.047 Active smoking 20 (25.30) 20 (19.20) 0.324 Alcohol consumption 9 (11.40) 8 (7.70) 0.393 Obstructive sleep apnoea 6 (7.60) 12 (11.50) 0.375 Previous kidney failure 1 (1.30) 1 (1.00) 1 Previous cancer 12 (15.20) 15 (14.40) 0.885 Recent infection (<1 month) 2 (2.50) 7 (6.70) 0.303 Cardiovascular history Stroke or TIA 13 (16.50) 20 (19.20) 0.629 Peripheral artery disease 0 (0.00) 3 (2.90) 0.260 Heart failure 0 (0.00) 5 (4.80) 0.071 Cardiac valve disease 11 (13.90) 37 (35.60) 0.001 Coronary artery disease 2 (2.50) 12 (11.50) 0.023 Clinical data at admission Systolic pressure, mm Hg 155 (140–173.00) 161 (139–181) 0.453 Diastolic pressure, mm Hg 90 (78.00–97.00) 84 (74.00–92.00) 0.013 Heart rate, bpm 80 (67.75–90.50) 75 (67.00–83.25) 0.099 NIHSS score 4 (1.00–7.00) 4 (3.00–7.00) 0.040 CHA2DS2VASc score 2 (0.00–3.00) 3 (2.00–4.00) <0.001 CHA2DS2VASc score≥2 41 (51.90) 86 (82.70) <0.001 Revascularisation IV thrombolysis or mechanical thrombectomy 4 (5.10) 12 (11.50) 0.125 Bold face values signfies p<0.05
BMI, body mass index; bpm, beat per minute; IQR, interquartile range; IV, intravenous; NIHSS, National Institute of Health Stroke Scale; SR, sinus rhythm; TIA, transient ischaemic attack.
- Table 2
Biological, imaging and electrocardiographic characteristics of patients at admission (n(%) or median (IQR))
No atrial cardiomyopathy (n=79 (44%)) Atrial cardiomyopathy (n=104 (56%)) P Biological data CRP>3, mg/mL 23 (29.10) 48 (46.20) 0.019 Creatinine, µmol/L 72 (61.00–86.00) 76.50 (63.50–91.75) 0.174 Troponin>0.02 ng/L 3 (3.80) 20 (19.40) 0.002 NT-pro-BNP, pg/mL 83 (44.00–128.00) 515.50 (252.50–1266.00) <0.001 NT-pro-BNP≥250 pg/mL 0 (0.00) 79 (76.00) <0.001 Hba1c, % 5.80 (5.50–6.10) 5.80 (5.60–6.10) 0.350 LDL cholesterol, mmol/l 3.09 (2.41–3.86) 2.70 (1.95–3.44) 0.017 Haemoglobin, g/dl 14.60 (13.40–15.40) 13.80 (12.60–14.70) 0.006 Leukocytes, g/dl 8.00 (6.60–10.40) 8.55 (6.83–10.50) 0.419 Platelets, g/dl 252 (215–295) 227 (188–282) 0.069 TSH (UI/l) 1.56 (0.80–2.14) 1.29 (0.77–2.05) 0.299 Imaging data Multi-territory stroke 6 (7.6) 14 (13.5) 0.208 Vertebrobasilar stroke 27 (34.2) 35 (33.70) 0.941 Bilateral stroke 6 (7.60) 13 (12.50) 0.281 Insular stroke 8 (10.10) 23 (22.10) 0.003 Cerebellar stroke 6 (7.60) 13 (12.50) 0.281 Thalamic stroke 5 (6.30) 6 (5.80) 0.875 Anterior choroidal stroke 5 (6.30) 4 (3.80) 0.503 Posterior fossa stroke 15 (19.00) 25 (24.00) 0.413 Superficial MCA stroke 24 (30.40) 62 (59.60) <0.001 Deep MCA stroke 27 (34.20) 21 (20.20) 0.033 ACA stroke 2 (2.50) 7 (6.70) 0.696 Superior PCA stroke 9 (11.40) 10 (9.6) 0.808 Choroidal stroke 5 (6.30) 4 (3.80) 0.503 Mesencephalic stroke 3 (3.80) 2 (1.90) 0.653 Pontine stroke 6 (7.60) 12 (11.50) 0.375 Bulbar stroke 2 (2.50) 2 (1.90) 1 Other 4 (5.10) 0 (0.00) 0.033 ECG data P-wave duration downwards, ms 40 (40.00–40.00) 60 (40.00–60.00) <0.001 P-wave duration, ms 85 (80.00–100.00) 90 (80.00–110.00) 0.160 P-wave maximum duration, ms 100 (100.00–120.00) 120 (100.00–120.00) 0.059 PTFV1, mV.ms 0 (0–4) 4 (0–6) <0.001 PTF≥5 mv.ms 0 (0.00) 47 (45.2) <0.001 PR duration, ms 170 (149.00–186.50) 170 (151.00–194.00) 0.574 QRS duration, ms 90 (84.00–98.00) 92 (82.00–107.00) 0.286 Corrected QTc duration, ms 424.50 (411.25–443.50) 433.00 (412.50–447.50) 0.358 Echocardiographic data LA volume, mL 45.00 (35.00–59.00) 56.65 (41.07–76.32) 0.001 LAVI, mL/m² 25.45 (18.71–31.07) 32.02 (22.21–42.57) <0.001 LAVI>34 mL/m² 12 (6.5) 47 (25.7) <0.001 LA diameter, cm 3.60 (3.20–3.90) 3.80 (3.30–4.20) 0.041 LADI, cm/m² 1.88 (1.69–2.05) 2.03 (1.81–2.28) 0.002 LA surface, cm² 16.90 (15.00–21.00) 19.70 (16.35–25.10) 0.001 LVEF 60 (58.00–66.00) 60 (55.00–65.00) 0.016 PFO 10 (12.70) 9 (8.70) 0.465 ACA, anterior cerebral artery; AF, atrial fibrillation; CRP, C reactive protein; ECG, electrocardiogram; IQR, interquartile range; LA, left atria; LADI, left atrial diameter indexed; LAVI, left atrial volume indexed; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; MCA, middle cerebral artery; NT-pro-BNP, N-Terminal pro-B-type natriuretic peptide; PCA, posterior cerebral artery; PFO, patent foramen ovale; PTF, P-wave terminal force; RBBB, right bundle branch block; SR, sinus rhythm.
- Table 3
Stroke aetiology and follow-up (n (%) or median (IQR))
No atrial cardiomyopathy (n=79 (44%)) Atrial cardiomyopathy (n=104 (56%)) P Aetiology and management Cryptogenic 47 (59.50) 59 (56.7) 0.708 Implantable loop recorder 29 (36.70) 41 (39.40) 0.760 Follow-up Atrial fibrillation at 6 months 11 (13.99) 34 (32.7) 0.003 Recurrent stroke/TIA at 6 months 1 (1.30) 5 (5.10) 0.229 Vascular event at 6 months 0 (0.00) 1 (1.00) 1 Haemorrhage at 6 months 1 (1.00) 1 (1.00) 0.694 Death 1 (1.30) 7 (6.70) 0.072 TIA, transient ischaemic attack.
- Table 4
Univariate and multivariate backward stepwise analysis of atrial cardiomyopathy-associated factors
Variable Univariate Multivariate OR 95% CI p OR 95% CI p Age 1.07 1.04 to 1.10 <0.001 1.073 1.04 to 1.10 <0.001 Hypertension 2.48 1.36 to 4.52 0.003 Coronary artery disease 5.02 1.09 to 23.2 0.038 Haemoglobin 0.79 0.66 to 0.94 0.009 CRP>3 mg/mL 2.09 1.12 to 3.88 0.020 2.60 1.30 to 5.21 0.007 Troponin>0.02 ng/L 6.10 1.74 to 21.36 0.005 Diabetes 2.17 1.00 to 4.70 0.050 CRP, C reactive protein.
- Table 5
Univariate and multivariate backward stepwise analysis of AFDAS-associated factors
Univariate Multivariate model 1 Multivariate model 2 Variable OR 95% CI p OR 95% CI p OR 95% CI p Age 1.087 1.049 to 1.126 <0.001 1.088 1.048 to 1.130 <0.001 1.079 1.040 to 1.119 <0.001 Female sex 2.19 1.11 to 4.35 0.024 Diastolic BP 0.97 0.95 to 0.99 0.022 Superficial MCA stroke 2.27 1.14 to 4.53 0.020 NIHSS 1.059 1.002 to 1.118 0.041 1.070 1.005 to 1.139 0.035 AC 3.01 1.41 to 6.40 0.004 Not included LAVI>34 mL/m2 2.96 1.48 to 5.95 0.002 Not included 2.351 1.090 to 5.067 0.029 Multivariate model 1 includes age, female sex, diastolic BP, sup MCA stroke, NIHSS and AC. Multivariate model 2 includes age, female sex, diastolic BP, sup MCA stroke, NIHSS and LAVI>34 mL/m2.
AC, atrial cardiomyopathy as defined in ARCADIA; BP, blood pressure; LAVI, indexed left atrial volume; MCA, middle cerebral artery; NIHSS, National Institute of Health Stroke Scale.
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