Atrial cardiomyopathy and incident ischemic stroke risk: a systematic review and meta-analysis

Background and purpose Growing evidence suggests that atrial cardiomyopathy may play an essential role in thrombosis and ischemic stroke. The aim of this systematic review and meta-analysis was to quantify the values of cardiomyopathy markers for predicting ischemic stroke risk. Methods PubMed, Embase, and the Cochrane Library were searched for longitudinal cohort studies evaluating the association between cardiomyopathy markers and incident ischemic stroke risk. Results We included 25 cohort studies examining electrocardiographic, structural, functional, and serum biomarkers of atrial cardiomyopathy involving 262,504 individuals. P-terminal force in the precordial lead V1 (PTFV1) was found to be an independent predictor of ischemic stroke as both a categorical variable (HR 1.29, CI 1.06–1.57) and a continuous variable (HR 1.14, CI 1.00–1.30). Increased maximum P-wave area (HR 1.14, CI 1.06–1.21) and mean P-wave area (HR 1.12, CI 1.04–1.21) were also associated with an increased risk of ischemic stroke. Left atrial (LA) diameter was independently associated with ischemic stroke as both a categorical variable (HR 1.39, CI 1.06–1.82) and a continuous variable (HR 1.20, CI 1.06–1.35). LA reservoir strain independently predicted the risk of incident ischemic stroke (HR 0.88, CI 0.84–0.93). N-terminal pro-brain natriuretic peptide (NT-proBNP) was also associated with incident ischemic stroke risk, both as a categorical variable (HR 2.37, CI 1.61–3.50) and continuous variable (HR 1.42, CI 1.19–1.70). Conclusion Atrial cardiomyopathy markers, including electrocardiographic markers, serum markers, LA structural and functional markers, can be used to stratify the risk of incident ischemic stroke.