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Abstract 141: Atrial Cardiopathy And Left Ventricular Dysfunction In Patients With ESUS: Findings From The Arcadia Trial


 Background:
 Recent data suggest biomarkers of atrial cardiopathy (ACP) can potentially identify a subset of patients with cryptogenic stroke who may benefit from anticoagulation. However, the specificity of these markers for atrial disease and their independence from measures of more global cardiac dysfunction remain unclear. We hypothesized that biomarkers of ACP collectively reflect left atrial pathology and are not strongly affected by coexisting left ventricular dysfunction.
 
 
 Methods:
 ARCADIA is an ongoing multicenter trial comparing standard dose apixaban to aspirin therapy in patients with Embolic Stroke of Undetermined Source (ESUS) with ACP, defined as either N-terminal pro-brain natriuretic peptide [NT-proBNP] > 250 pg/mL; P wave terminal force velocity on ECG lead V1 [PTFV1] > 5000 μV*ms; or echocardiographic left atrial diameter index [LADI] ≥ 3 cm/m
 2
 . Pearson correlation coefficients and descriptive statistics were used to examine the relationship between left ventricular ejection fraction (LVEF) and ACP biomarkers.
 
 
 Results:
 Among 2,616 ESUS patients screened, 1,046 met ≥ 1 ACP criterion (665 BNP, 531 PTFV1, 14 LADI). Patients with ACP were older (68 ± 11 vs 64 ± 10 years) and 54.5% were women. The great majority (84%) of subjects with ACP had normal LVEF (≥55%). Among them there was no correlation between LVEF and NT-proBNP (r= -0.01, P= 0.5) or PTFV1 (r=0.002, P=0.9). In patients with abnormal LVEF, there was a strong inverse correlation of LVEF with NT-proBNP (r=-0.4, P<0.001), but no correlation with PTFV1 (r=0.11, P=0.16). The LADI criterion was only met in a few patients, precluding further analyses. Among patients with NT-proBNP >250 pg/mL and measured LVEF (n=435), only 19% had abnormal LVEF. Compared to patients with abnormal NT-proBNP alone, those with both abnormal NT-proBNP and abnormal LVEF were younger (66.4 ± 11.0 vs. 71.6 ± 11.0, P<0.001), more often African American (29.6% vs. 11.5%, P<0.001), and more often male (56% vs. 40%, P=0.01).
 
 
 Conclusion:
 Left ventricular dysfunction (EF ≤ 55%) is uncommon in patients with ACP as defined in ARCADIA. These findings suggest that, among patients with ESUS, atrial cardiopathy may represent a separate entity from LV dysfunction.
