Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source

Sapna Erat Sreedharan; Kakarla Saikiran; S C Chandralekha; C A Athira; P N Sylaja; V T Jissa; Narayanan Namboodiri

doi:10.4103/aian.aian_772_24

Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source

Ann Indian Acad Neurol. 2025 Jan 10. doi: 10.4103/aian.aian_772_24. Online ahead of print.

Authors

Sapna Erat Sreedharan¹, Kakarla Saikiran², S C Chandralekha¹, C A Athira¹, P N Sylaja¹, V T Jissa³, Narayanan Namboodiri²

Affiliations

¹ Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
² Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
³ Department of Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

PMID: 39794287
DOI: 10.4103/aian.aian_772_24

Abstract

Background and objectives: Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE.

Methods: This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes.

Results: We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes.

Conclusions: The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.