-Original-

Prevalence of Atrial Cardiopathy Biomarkers Across Ischemic Stroke Subtypes

Yuji Kato¹, Shintaro Nakano², Takeshi Hayashi¹, Shunsuke Kido¹, Kiichiro Oryu¹, Noriko Arai¹, Toru Nakagami¹, Ichiro Deguchi¹, Shinichi Takahashi¹, Shinya Kohyama³, Satoshi Suda^1,4 and Junya Aoki¹

¹Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan
²Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
³Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
⁴Department of Neurology, Nippon Medical School, Tokyo, Japan

Background: Atrial cardiopathy (AC) has been proposed as a potential embolic mechanism in embolic stroke of undetermined source (ESUS); however, the distribution of AC biomarkers across ischemic stroke subtypes remains unclear.
Methods: We retrospectively analyzed 533 consecutive patients with acute ischemic stroke. Stroke subtypes were classified as small-vessel occlusion (SVO), branch atheromatous disease (BAD), large-artery atherosclerosis (LAA), ESUS, or cardioembolism (CE). AC was defined according to ARCADIA trial criteria as the presence of at least one of the following: P-wave terminal force in lead V1 (PTFV1) >5,000 μV·ms, N-terminal pro–brain natriuretic peptide (NT-proBNP) >250 pg/mL, or left atrial diameter index (LADI) ≥3 cm/m². We evaluated the prevalence and overlap of these biomarkers across subtypes.
Results: AC biomarkers were significantly more frequent in CE than in other subtypes. Using ≥1 biomarker, AC prevalence was 43% in SVO, 49% in BAD, 53% in LAA, 54% in ESUS, and 97% in CE. With ≥2 biomarkers, prevalence decreased to 8%, 7%, 13%, 19%, and 78%, respectively. NT-proBNP elevation was the most common biomarker across all groups. Left atrial enlargement was rare in non-CE subtypes (~5%) and showed no overlap with PTFV1 in SVO, BAD, or LAA.
Conclusions: While AC defined by ARCADIA criteria is highly prevalent in CE, it is also widely observed across other stroke subtypes. Refinement of AC definitions, including stricter thresholds and/or biomarker combinations, may better identify atrial dysfunction with causal relevance to stroke.

J Nippon Med Sch 2026; 93: 394-401

Keywords
P-wave terminal force in lead V1, N-terminal pro-brain natriuretic peptide, left atrial diameter index, embolic stroke of undetermined source

Correspondence to
Yuji Kato
yujik@saitama-med.ac.jp

Received, April 13, 2026
Accepted, July 22, 2026