Aruta, Francesco (2024) The role of Atrial Cardiopathy as potential cause of Embolic Stroke of Undetermined Source. [Tesi di dottorato]

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Abstract

Background. Atrial cardiopathy (AC) is considered a potential mechanism of embolic stroke of undetermined source (ESUS). Etiological misclassification may have limited our understanding of the link between AC and ESUS due to the heterogeneous ESUS construct. After application of a recently proposed ESUS update, we investigated the role of AC in ESUS. Methods. A retrospective single-center study on consecutive ESUS patients from 2018-to-2022 was conducted. AC was defined as left atrial enlargement measured by left atrial volume index >34mL/m2. We assessed clinical and radiological features of AC(+)/ESUS and the association between AC and stroke severity, 90-day functional outcome, stroke recurrence and atrial fibrillation detection after stroke (AFDAS). Results. AC(+)/ESUS were older, had more frequently hypertension, coronary-artery-disease, supracardiac atherosclerosis and cortico-subcortical lesions compared to AC()/ESUS. Recurrent ischemic stroke in these patients [AC(+)] occurred in 5.9% and AFDAS in 9.7%. No significant association was found between AC and stroke severity, 90-day outcome and stroke recurrence. AFDAS was independently associated with AC. Conclusion. AC is associated with AFDAS, but not with stroke severity, stroke recurrence, or 90-day functional outcome in ESUS classified according to the proposed construct update.

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