The following is a summary of “Embolic stroke of undetermined source: Focusing on atrial cardiopathy and patent foramen ovale,” published in the January 2024 issue of Cardiology by Zhang et al.

In the investigation of embolic strokes of undetermined source (ESUS), atrial cardiopathy (AC) and patent foramen ovale (PFO) emerge as significant etiological factors. A total of 1,146 participants, comprising the ESUS group and those with non-embolic strokes, specifically large arterial atherosclerosis (LAA) + small artery occlusion (SAO), were enrolled between January 2019 and June 2022. AC was defined by the presence of specific criteria, including P-wave terminal force in lead V1 (PTFV1) > 4,000 μV*ms in electrocardiograms, N-terminal probrain natriuretic peptide (NT-proBNP) > 250 pg/mL in laboratory tests, or left atrial diameter (LAD) > 3.8 cm for women and > 4.0 cm for men in cardiac ultrasound. The assessment of PFO involved various diagnostic modalities, and a pathogenic PFO was determined by a RoPE score of 7 to 10. The ESUS group exhibited a higher prevalence of both AC and PFO compared to the LAA + SAO group. 

Notably, the prevalence of AC was notably lower in ESUS patients with pathogenic PFO (37.9%) compared to those without PFO (68.4%) or with incidental PFO (64.0%) (p = 0.006). Conversely, the prevalence of pathogenic PFO was lower in ESUS patients with AC (6.0%) compared to those without AC (17.8%) (p = 0.006). PTFV1 demonstrated significant predictive value for ESUS, with an area under the curve (AUC) of 0.724 [95% CI (0.686–0.762), p < 0.05], establishing it as the most valuable AC biomarker for predicting ESUS. In conclusion, the prevalence of AC exhibits an inverse relationship with the prevalence of pathogenic PFO in ESUS patients, and PTFV1 proves to be a pivotal predictive index among AC biomarkers for ESUS.

Source: sciencedirect.com/science/article/abs/pii/S016752732400175X