Secondary Stroke Prevention Following Embolic Stroke of Unknown Source in the Absence of Documented Atrial Fibrillation: A Clinical Review

Autor: Mark D O'Neill, Amedeo Chiribiri, Iain Sim, Rahul K Mukherjee, Steven Williams, Ajay Bhalla, Irum Kotadia, Jonathan Birns, Daniel O'Hare
Jazyk: angličtina
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Stroke recurrence
Cardiomyopathy
cardiac magnetic resonance imaging
Atrial cardiomyopathy
030204 cardiovascular system & hematology
electrocardiogram
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Cardiac magnetic resonance imaging
Recurrence
Risk Factors
Internal medicine
Contemporary Review
Atrial Fibrillation
medicine
ischemic stroke
Secondary Prevention
Humans
cardiovascular diseases
atrial cardiomyopathy
embolic stroke of unknown source
Embolic Stroke
medicine.diagnostic_test
business.industry
Ischemic strokes
Anticoagulants
Atrial fibrillation
medicine.disease
Embolic stroke
Unknown Source
Treatment Outcome
Stroke prevention
Cardiology
Cardiology and Cardiovascular Medicine
business
Cardiomyopathies
030217 neurology & neurosurgery
Platelet Aggregation Inhibitors
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Approximately one‐third of ischemic strokes are classified as cryptogenic strokes. The risk of stroke recurrence in these patients is significantly elevated with up to one‐third of patients with cryptogenic stroke experiencing a further stroke within 10 years. While anticoagulation is the mainstay of treatment for secondary stroke prevention in the context of documented atrial fibrillation (AF), it is estimated that up to 25% of patients with cryptogenic stroke have undiagnosed AF. Furthermore, the historical acceptance of a causal relationship between AF and stroke has recently come under scrutiny, with evidence to suggest that embolic stroke risk may be elevated even in the absence of documented atrial fibrillation attributable to the presence of electrical and structural changes constituting an atrial cardiomyopathy. More recently, the term embolic stroke of unknown source has garnered increasing interest as a subset of patients with cryptogenic stroke in whom a minimum set of diagnostic investigations has been performed, and a nonlacunar infarct highly suspicious of embolic etiology is suspected but in the absence of an identifiable secondary cause of stroke. The ongoing ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke) randomized trial and ATTICUS (Apixiban for Treatment of Embolic Stroke of Undetermined Source) study seek to further define this novel term. This review summarizes the relationship between AF, embolic stroke, and atrial cardiomyopathy and provides an overview of the clinical relevance of cardiac imaging, electrocardiographic, and serum biomarkers in the assessment of AF and secondary stroke risk. The implications of these findings on therapeutic considerations is considered and gaps in the literature identified as areas for future study in risk stratifying this cohort of patients.
Databáze: OpenAIRE
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