Atrial Cardiopathy and Cardioembolic Stroke

EditorialsJanuary 2023Atrial Cardiopathy and Cardioembolic StrokeDarae Ko, MD, MSc and Emelia J. Benjamin, MD, ScMDarae Ko, MD, MScSection of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MassachusettsSearch for more papers by this author and Emelia J. Benjamin, MD, ScMSection of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MassachusettsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3476 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Atrial fibrillation (AF) is the most common cause of cardioembolic stroke, accounting for 1 in every 4 ischemic strokes (1). According to the current paradigm, cardioembolic stroke in nonvalvular AF is caused by thrombus formation in the left atrium, most often in the left atrial appendage, from a lack of organized atrial contraction. Echocardiographic markers of blood stasis, including spontaneous echocardiographic contrast (smokelike pattern caused by swirling blood flow most often seen in the left atrium) and low left atrial appendage emptying velocity, are associated with increased risk for left atrial appendage thrombus and thromboembolism in AF (2). The presence ...References1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022;145:e153-e639. [PMID: 35078371] doi:10.1161/CIR.0000000000001052 CrossrefMedlineGoogle Scholar2. Goldberger JJ, Arora R, Green D, et al. Evaluating the atrial myopathy underlying atrial fibrillation: identifying the arrhythmogenic and thrombogenic substrate. Circulation. 2015;132:278-91. [PMID: 26216085] doi:10.1161/CIRCULATIONAHA.115.016795 CrossrefMedlineGoogle Scholar3. Goette A, Kalman JM, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016;18:1455-1490. [PMID: 27402624] CrossrefMedlineGoogle Scholar4. Elkind MSV. Atrial cardiopathy and stroke prevention. Curr Cardiol Rep. 2018;20:103. [PMID: 30209635] doi:10.1007/s11886-018-1053-0 CrossrefMedlineGoogle Scholar5. Longstreth WT Jr, Kronmal RA, Thompson JL, et al. Amino terminal pro-B-type natriuretic peptide, secondary stroke prevention, and choice of antithrombotic therapy. Stroke. 2013;44:714-9. [PMID: 23339958] doi:10.1161/STROKEAHA.112.675942 CrossrefMedlineGoogle Scholar6. Hart RG, Sharma M, Mundl H, et al; NAVIGATE ESUS Investigators. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378:2191-2201. [PMID: 29766772] doi:10.1056/NEJMoa1802686 CrossrefMedlineGoogle Scholar7. Diener HC, Sacco RL, Easton JD, et al; RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for prevention of stroke after embolic stroke of undetermined source. N Engl J Med. 2019;380:1906-1917. [PMID: 31091372] doi:10.1056/NEJMoa1813959 CrossrefMedlineGoogle Scholar8. Maheshwari A, Norby FL, Inciardi RM, et al. Left atrial mechanical dysfunction and the risk for ischemic stroke in people without prevalent atrial fibrillation or stroke. A prospective cohort study. Ann Intern Med. 2023;176:39-48. doi:10.7326/M22-3476 Google Scholar9. van der Endt VHW, Milders J, Penning de Vries BBL, et al. Comprehensive comparison of stroke risk score performance: a systematic review and meta-analysis among 6 267 728 patients with atrial fibrillation. Europace. 2022;24:1739-1753. [PMID: 35894866] doi:10.1093/europace/euac096 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MassachusettsSection of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3476.Corresponding Author: Darae Ko, MD, MSc, 72 East Newton Street, Boston, MA 02118; e-mail, [email protected]edu.This article was published at Annals.org on 20 December 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLeft Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke Ankit Maheshwari , Faye L. Norby , Riccardo M. Inciardi , Wendy Wang , Michael J. Zhang , Elsayed Z. Soliman , Alvaro Alonso , Michelle C. Johansen , Rebecca F. Gottesman , Scott D. Solomon , Amil M. Shah , and Lin Yee Chen Metrics January 2023Volume 176, Issue 1Page: 131-132KeywordsLeft atriumStrokeThromboembolismThrombosis ePublished: 20 December 2022 Issue Published: January 2023 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...