Arrhythmias & electrophysiologyCohort study
Electrical and Structural Atrial Remodeling Identifies a High-Risk Phenotype in Embolic Stroke of Undetermined Source
- prospective single-center study
- consecutive patients
- age- and sex-matched controls
Authors' conclusion
Multimodal assessment of electrical and structural atrial remodeling identifies a subgroup of ESUS patients with an increased risk of adverse events. These findings underscore the potential clinical relevance of atrial cardiomyopathy and may support further evaluation in future rhythm-guided or anticoagulation studies.
Study context
- Population
- Patients with embolic stroke of undetermined source (ESUS) and controls without known cardiac diseaseESUS patients 103 · controls 123
- Participants
- 103 vs 123
- Exposure
- ESUS patients compared with controls
- ESUS patientsn = 103
- controlsn = 123
- Outcome
- Composite of:
- All-cause death
- Recurrent stroke
- Transient ischemic attack
- Myocardial infarction
- Newly diagnosed atrial fibrillation
- Follow-up
- Median 382 days (IQR: 366-697 days)
Main finding
As reported in the abstract
ESUS patients
28%
29 of 103
Observational data: associations, not effects.
Further findings
NT-proBNP, advanced interatrial block, left atrial function
- ESUS patients exhibited higher NT-proBNP, more frequent advanced interatrial block, and impaired left atrial function compared with controls
Independent predictors of the primary endpoint
- NT-proBNP
- >420 pg/mL
- E'
- ≤9 cm/s
- left atrial volume index
- ≥29 mL/m²
- left atrial ejection fraction
- <50%
- advanced interatrial block
- multivariable Cox regression
Event-free survival in subgroup with risk score ≥3 markers · 1 year
- Kaplan-Meier estimated event-free survival
- approximately 50% (95% CI: 31.6%-68.4%)
Original publication
Electrical and Structural Atrial Remodeling Identifies a High-Risk Phenotype in Embolic Stroke of Undetermined Source. JACC Adv. Published 9 July 2026. doi:10.1016/j.jacadv.2026.102990
Summarised from the published abstract; every number is checked against it