Background and Purpose- Atrial cardiopathy and atherosclerotic plaque are two potential mechanisms underlying embolic strokes of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear. A better understanding of their association may inform targeted secondary prevention strategies. Methods- We examined the association between atrial cardiopathy and atherosclerotic plaque in the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), which enrolled 7213 patients with recent ESUS during 2014 to 2017. For this analysis, we included patients with data on left atrial dimension, location of brain infarction, and cervical large artery plaque. The variables of primary interest were left atrial diameter and cervical plaque ipsilateral to brain infarction. Secondary markers of atrial cardiopathy were premature atrial contractions on Holter monitoring and newly diagnosed atrial fibrillation. For descriptive purposes, left atrial enlargement was defined as ≥4.7 cm. Multivariable logistic regression was used to examine the association between atrial cardiopathy markers and ipsilateral plaque after adjustment for age, sex, body mass index, hypertension, diabetes mellitus, current smoking, and hyperlipidemia. Results- Among 3983 eligible patients, 235 (5.9%) had left atrial enlargement, 939 (23.6%) had ipsilateral plaque, and 94 (2.4%) had both. Shared risk factors for left atrial enlargement and ipsilateral plaque were male sex, white race, hypertension, tobacco use, and coronary artery disease. Despite shared risk factors, increasing left atrial dimension was not associated with ipsilateral plaque after adjustment for covariates (odds ratio per cm, 1.1 [95% CI, 1.0-1.2]; P=0.08). We found no consistent associations between secondary markers of atrial cardiopathy and ipsilateral plaque. Conclusions- In a large population of patients with ESUS, we did not observe a notable association between atrial cardiopathy and atherosclerotic plaque, and few patients had both conditions. These findings suggest that atrial cardiopathy and atherosclerotic plaque may be distinct, nonoverlapping risk factors for stroke among ESUS patients.

中文翻译：

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不明来源栓塞性卒中患者的心房心脏病和非狭窄性大动脉斑块。

背景和目的 - 心房心脏病和动脉粥样硬化斑块是不明来源栓塞性卒中 (ESUS) 的两种潜在机制。ESUS 患者中这两种机制之间的关系尚不清楚。更好地了解它们的关联可以为有针对性的二级预防策略提供信息。方法——我们在 NAVIGATE ESUS 试验（全球试验中利伐沙班抑制因子 Xa 的新方法与 ASA 预防不明来源栓塞性卒中栓塞的新方法）中检查了心房心脏病和动脉粥样硬化斑块之间的关联，该试验招募了 7213 名近期 ESUS 患者2014 年至 2017 年。在此分析中，我们纳入了具有左心房尺寸、脑梗塞位置和颈部大动脉斑块数据的患者。主要感兴趣的变量是左心房直径和脑梗塞同侧的宫颈斑块。房性心脏病的次要标志是动态心电图监测的房性早搏和新诊断的房颤。出于描述目的，左心房扩大定义为≥4.7 cm。在调整年龄、性别、体重指数、高血压、糖尿病、当前吸烟和高脂血症后，使用多变量逻辑回归来检查房性心脏病标志物与同侧斑块之间的关联。结果——在 3983 名符合条件的患者中，235 名 (5.9%) 有左心房扩大，939 名 (23.6%) 有同侧斑块，94 名 (2.4%) 两者都有。左心房扩大和同侧斑块的共同危险因素是男性、白种人、高血压、吸烟、和冠状动脉疾病。尽管存在共同的风险因素，但在调整协变量后，左心房尺寸的增加与同侧斑块无关（每厘米的比值比，1.1 [95% CI，1.0-1.2]；P=0.08）。我们发现心房性心脏病的二级标志物与同侧斑块之间没有一致的关联。结论——在大量 ESUS 患者中，我们没有观察到心房心脏病和动脉粥样硬化斑块之间存在显着关联，并且很少有患者同时患有这两种情况。这些发现表明，在 ESUS 患者中，心房心脏病和动脉粥样硬化斑块可能是不同的、不重叠的卒中危险因素。08）。我们发现心房性心脏病的二级标志物与同侧斑块之间没有一致的关联。结论——在大量 ESUS 患者中，我们没有观察到心房心脏病和动脉粥样硬化斑块之间存在显着关联，并且很少有患者同时患有这两种情况。这些发现表明，在 ESUS 患者中，心房心脏病和动脉粥样硬化斑块可能是不同的、不重叠的卒中危险因素。08）。我们发现心房性心脏病的二级标志物与同侧斑块之间没有一致的关联。结论——在大量 ESUS 患者中，我们没有观察到心房心脏病和动脉粥样硬化斑块之间存在显着关联，并且很少有患者同时患有这两种情况。这些发现表明，在 ESUS 患者中，心房心脏病和动脉粥样硬化斑块可能是不同的、不重叠的卒中危险因素。