Evidence map›Paper›PMID 41766531›Full record

Observational studyStroke2026

Recurrent Stroke in Patients With Cryptogenic Stroke and Left Ventricular Injury: The Cardiac Abnormalities in Stroke Prevention and Recurrence (CASPR) Study.

Richa Sharma, Katelyn F McNamara, Elena Badillo Goicoechea, Anna Bowman, Russell Van Coevering, Lucia Chen, Mary Penckofer, Eesha Singh, Deborah Kerrigan, Hassan Aboul-Nour and 38 more

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Stroke, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06398366 (Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06398366 enrolling by invitationnot on this map

Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence (CASPR): a Multi-center Observational Cohort Study

TypeobservationalSponsorThe Cooper Health SystemRan2022 to 2026Enrolled2,000ConditionsCryptogenic Stroke
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

48 authors.

Richa Sharma *Department of Neurology, Yale University School of Medicine, New Haven, CT (R.S., K.F.M., N.T., A.d.H.).ORCID 0000-0003-0798-2353
Katelyn F McNamara *Department of Neurology, Yale University School of Medicine, New Haven, CT (R.S., K.F.M., N.T., A.d.H.).ORCID 0000-0003-0925-4755
Elena Badillo GoicoecheaDepartment of Neurology, University of Chicago, IL (E.B.G., E.S., M. Smith, J.E.S.).ORCID 0000-0003-1653-1247
Anna BowmanDepartment of Neurology, University of Colorado School of Medicine, Aurora (A.B., R.V.C., L.C., K.E.).ORCID 0009-0006-5223-8303
Russell Van CoeveringDepartment of Neurology, University of Colorado School of Medicine, Aurora (A.B., R.V.C., L.C., K.E.).ORCID 0009-0009-4798-5189
Lucia ChenDepartment of Neurology, University of Colorado School of Medicine, Aurora (A.B., R.V.C., L.C., K.E.).ORCID 0009-0007-7080-9955
Mary PenckoferCooper Neurological Institute, Cooper Medical School of Rowan University, Camden, NJ (M.P., J.M.T., J.E.S.).ORCID 0000-0002-7192-8557
Eesha SinghDepartment of Neurology, University of Chicago, IL (E.B.G., E.S., M. Smith, J.E.S.).ORCID 0000-0003-0549-0902
Deborah KerriganDepartment of Neurology, Vanderbilt University Medical Center, Nashville, TN (E.S., D.K., J.K.).ORCID 0000-0002-1722-6677
Hassan Aboul-NourDepartment of Neurology, Trinity Health, Ann Arbor, MI (H.A.-N.).ORCID 0000-0002-6698-5848
Fadi NahabDepartment of Neurology, Emory University School of Medicine, Atlanta, GA (F.N., P.G., S.L.T., D.J., J.-P.A.D.).ORCID 0000-0003-1710-9881
Patrick GloverDepartment of Neurology, Emory University School of Medicine, Atlanta, GA (F.N., P.G., S.L.T., D.J., J.-P.A.D.).
Balaji KrishnaiahDepartment of Neurology, University of Tennessee Health Science Center, Memphis (B.K., C.E.).ORCID 0000-0002-5825-1799
Shadi YaghiDepartment of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S.Y., F. Khan, C.S.).ORCID 0000-0003-0031-1004
Farid KhasiyevDepartment of Neurology, University of Minnesota, Minneapolis (F. Khasiyev, G.L.).ORCID 0000-0002-3127-0973
Christina M LinebackDepartment of Neurology, University of Michigan, Ann Arbor (C.M.L.).ORCID 0000-0003-2048-333X
Emiliya MelkumovaDepartment of Neurology, Tufts University School of Medicine, Boston, MA (E.M., R.A.C., W.Y.).ORCID 0009-0008-7429-6525
Collin CulbertsonDepartment of Neurology, Lahey Medical Center, Burlington, MA (C.C.).ORCID 0000-0002-9814-6811
Thanh N NguyenDepartment of Neurology, Neurosurgery, and Neuroradiology, Boston Medical Center, MA (T.N.N.).ORCID 0000-0002-2810-1685
Sean L ThompsonDepartment of Neurology, Emory University School of Medicine, Atlanta, GA (F.N., P.G., S.L.T., D.J., J.-P.A.D.).
Dinesh JillellaDepartment of Neurology, Emory University School of Medicine, Atlanta, GA (F.N., P.G., S.L.T., D.J., J.-P.A.D.).ORCID 0000-0002-5399-0170
Jean-Philippe Auguste DanielDepartment of Neurology, Emory University School of Medicine, Atlanta, GA (F.N., P.G., S.L.T., D.J., J.-P.A.D.).
Yasmin AzizDepartment of Neurology, University of Cincinnati, OH (Y.A.).ORCID 0000-0002-3515-4005
Muhammad AlviDepartment of Neurology, West Virginia University Health Sciences, Morgantown (M.A.).
Franziska HerpichDepartment of Neurology, Christiana Care, Newark, DE (F.H.).ORCID 0000-0003-0800-8536
Mahan ShahrivariDepartment of Neurology, University of Texas at Houston (M. Shahrivari).
Rafail A ChionatosDepartment of Neurology, Tufts University School of Medicine, Boston, MA (E.M., R.A.C., W.Y.).ORCID 0009-0002-0295-2817
Cheran ElangovanDepartment of Neurology, University of Tennessee Health Science Center, Memphis (B.K., C.E.).ORCID 0000-0002-9473-8051
Jieun KangDepartment of Neurology, Vanderbilt University Medical Center, Nashville, TN (E.S., D.K., J.K.).
Alicia ZhaDepartment of Neurology, Ohio State University Wexner Medical Center, Columbus (A.Z.).ORCID 0000-0002-3647-4158
Mudassir FarooquiDepartment of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.F.).ORCID 0000-0003-3697-5697
Aaron RothsteinDepartment of Neurology, Hospital of the University of Pennsylvania, Philadelphia (A.R.).ORCID 0000-0002-8480-8220
Farhan KhanDepartment of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S.Y., F. Khan, C.S.).ORCID 0000-0002-5958-6881
Matthew SmithDepartment of Neurology, University of Chicago, IL (E.B.G., E.S., M. Smith, J.E.S.).ORCID 0009-0005-0092-5518
Samantha J BrownDepartment of Neurology, Mayo Clinic, Phoenix, AZ (S.J.B.).ORCID 0009-0004-9117-909X
Ahmad Abu QdaisDepartment of Neurology, Neurosurgery, Medical University of South Carolina, Charlston (A.A.Q.).ORCID 0009-0002-8616-1712
David S LiebeskindDepartment of Neurology, University of California at Los Angeles (D.S.L.).ORCID 0000-0002-5109-8736
Nandini AbburiDepartment of Neurology, Duke University Hospital, Durham, NC (N.A.).ORCID 0000-0002-3794-8343
Stefano RozentalDepartment of Neurology, Dartmouth Health, Lebanon, NH (S.R.).
Simona NedelcuDepartment of Neurology, Brigham and Women's Hospital, Boston, MA (S.N.).ORCID 0000-0001-5473-1368
Jesse M ThonCooper Neurological Institute, Cooper Medical School of Rowan University, Camden, NJ (M.P., J.M.T., J.E.S.).ORCID 0000-0002-3255-760X
Christoph StretzDepartment of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S.Y., F. Khan, C.S.).ORCID 0000-0003-4125-4077
Neeharika ThottempudiDepartment of Neurology, Yale University School of Medicine, New Haven, CT (R.S., K.F.M., N.T., A.d.H.).
Wenzheng YuDepartment of Neurology, Tufts University School of Medicine, Boston, MA (E.M., R.A.C., W.Y.).
Kelsey EklundDepartment of Neurology, University of Colorado School of Medicine, Aurora (A.B., R.V.C., L.C., K.E.).ORCID 0000-0002-1120-2797
Guillermo LinaresDepartment of Neurology, University of Minnesota, Minneapolis (F. Khasiyev, G.L.).ORCID 0000-0001-8694-2645
Adam de HavenonDepartment of Neurology, Yale University School of Medicine, New Haven, CT (R.S., K.F.M., N.T., A.d.H.).ORCID 0000-0001-8178-8597
James E SieglerDepartment of Neurology, University of Chicago, IL (E.B.G., E.S., M. Smith, J.E.S.).ORCID 0000-0003-0287-3967

Funding

Classification of Stroke Etiology Using Advanced Computational ApproachesK23NS121634 · NINDS · YALE UNIVERSITY · PI Richa Sharma · 2022 to 2026
$951k
NINDS NIH HHS K23 NS121634
6 · The paper itself

Abstract

backgroundLeft ventricular (LV) dysfunction is a potential cardioembolic source of ischemic stroke, but its role in recurrent stroke risk and treatment response remains unclear. We explore whether LV injury associates with the risk of recurrent stroke and modifies the association between anticoagulation and stroke recurrence using real-world data.

methodsWe performed a multicenter, retrospective study of Cardiac Abnormalities in Stroke Prevention and Recurrence cohort across 27 US sites. Patients with LV ejection fraction ≥20% were included. LV injury, defined as LV ejection fraction 20% to 40% and wall motion abnormality, was the primary exposure and treatment effect modifier. The treatment of interest was anticoagulant versus antiplatelet therapy. The composite outcome included recurrent stroke, major bleeding, or death. Outcomes were evaluated using unadjusted and inverse probability weighting adjusted Cox proportional hazards models, with treatment effect modification tested by LV injury status.

resultsAmong 2685 patients enrolled, 2328 with complete data were analyzed (median age, 65 years; 49.8% female; median follow-up, 1.6 years). LV injury was present in 310 patients (13.3%). Overall, 535 events occurred: 258 recurrent ischemic strokes, 28 hemorrhagic strokes, 67 major hemorrhages, and 256 deaths. LV injury was associated with a higher unadjusted risk of the primary outcome (hazard ratio [HR], 1.51 [95% CI, 1.21-1.87]), though nonsignificant after inverse probability weighting adjustment (adjusted HR, 1.29 [95% CI, 0.97-1.70]). In the LV injury subgroup, anticoagulation versus antiplatelet therapy was associated with a lower risk of the primary outcome (adjusted HR, 0.24 [95% CI, 0.10-0.59]), relative to the non-LV injury subgroup (adjusted HR, 1.28 [95% CI, 0.83-1.95]; p[LV-interaction], 0.001). Similar interactions were seen for EF 20% to 40% (versus >40%; adjusted HR, 0.19 [95% CI, 0.04-0.86]; p[LV-interaction], 0.001) and wall motion abnormality (versus no wall motion abnormality; adjusted HR, 0.33 [95% CI, 0.15-0.73]).

conclusionsAfter cryptogenic stroke, anticoagulation in those with LV injury was associated with lower rates of recurrent stroke, major bleeding, and death. These findings warrant confirmation in a dedicated randomized controlled trial. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06398366.

Indexed as

Ischemic StrokeStrokeVentricular Dysfunction, LeftAgedAnticoagulantsFemaleHumansMaleMiddle AgedPlatelet Aggregation InhibitorsRecurrenceRetrospective StudiesAnticoagulantsPlatelet Aggregation Inhibitorsanticoagulantsembolic strokehemorrhagic strokeischemic strokeventricular dysfunction, left

Identifiers

PMID41766531
PMCPMC13615518

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.