Evidence mapPaperPMID 42425040Full record

ArticleJACC. Advances2026

Electrical and Structural Atrial Remodeling Identifies a High-Risk Phenotype in Embolic Stroke of Undetermined Source.

Niklas Bach, Louisa Bauermeister, Lisann Böhnke, Alexander Zuk, Stephan Salmen, Adnan Labedi, Vasileios Gkizas, Alanna Ebigbo, Ralf Gold, Arash Haghikia and 1 more

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Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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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

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Niklas BachDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Louisa BauermeisterDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Lisann BöhnkeDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Alexander ZukDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Stephan SalmenDepartment of Neurology, University Hospital St Josef Hospital Bochum, Germany.
Adnan LabediDepartment of Neurology, University Hospital St Josef Hospital Bochum, Germany.
Vasileios GkizasDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Alanna EbigboDepartment of Internal Medicine, University Hospital St Josef Hospital Bochum, Germany.
Ralf GoldDepartment of Neurology, University Hospital St Josef Hospital Bochum, Germany.
Arash HaghikiaDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany.
Michael GotzmannDepartment of Cardiology and Rhythmology, University Hospital St Josef Hospital Bochum, Germany. Electronic address: michael.gotzmann@rub.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmbolic stroke of undetermined source (ESUS) carries a substantial recurrence risk, yet anticoagulation has not proven superior to antiplatelet therapy in unselected patients. Atrial cardiomyopathy, reflecting electrical and structural atrial remodeling, may identify a high-risk ESUS subgroup.

objectivesThe purpose of this study was to characterize the extent of electrical and structural atrial remodeling in patients with ESUS and to evaluate its association with adverse cardiovascular outcomes during follow-up.

methodsIn this prospective single-center study, 103 consecutive ESUS patients and 123 age- and sex-matched controls without known cardiac disease underwent clinical evaluation, NT-proBNP measurement, 12-lead electrocardiogram, and transthoracic echocardiography. Patients were followed for ≥12 months. The primary endpoint was a composite of all-cause death, recurrent stroke, transient ischemic attack, myocardial infarction, or newly diagnosed atrial fibrillation. Independent predictors were determined using multivariable Cox regression.

resultsESUS patients exhibited higher NT-proBNP, more frequent advanced interatrial block, and impaired left atrial function compared with controls. Over a median follow-up of 382 days (IQR: 366-697 days), 29 ESUS patients (29/103, 28%) reached the primary endpoint. Independent predictors were NT-proBNP >420 pg/mL, advanced interatrial block, E' ≤9 cm/s, left atrial volume index ≥29 mL/m

conclusionsMultimodal assessment of electrical and structural atrial remodeling identifies a subgroup of ESUS patients with an increased risk of adverse events. These findings underscore the potential clinical relevance of atrial cardiomyopathy and may support further evaluation in future rhythm-guided or anticoagulation studies.

Indexed as

advanced interatrial blockatrial cardiomyopathyelectrocardiographyembolic stroke of undetermined sourceNT-proBNP

Identifiers

PMID42425040
PMCPMC13377156

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