Association of non-invasive atrial cardiomyopathy markers with cerebral stroke lesions: a population-based analysis from the Hamburg City Health Study

$\textbf{Aims}$
Atrial fibrillation (AF) is a well-known risk factor for ischaemic stroke. Emerging evidence suggests that atrial cardiomyopathy (AtCM), independent of AF, may be a key contributor to stroke risk. We aimed to evaluate whether non-invasive AtCM markers assessed by electrocardiography (ECG), transthoracic echocardiography (TTE), and blood-based biomarkers provide incremental diagnostic value beyond established clinical risk factors for identifying cerebral stroke lesions on magnetic resonance imaging (MRI).

$\textbf{Methods and results}$
We analysed 1794 Hamburg City Health Study participants who underwent cerebral MRI with available baseline 12-lead ECG and TTE in sinus rhythm. Logistic regression analyses were performed to identify associations between non-invasive AtCM markers and stroke lesions. The incremental discriminatory performance of these markers beyond clinical risk factors was assessed. Stroke lesions were present in 152 participants (8.5%). Male sex, history of prior AF, and higher CHA$_2$DS$_2$-VA score were significantly associated with stroke lesions. Among AtCM markers, amplified P-wave duration (APWD), P-wave area in lead II, PR interval, left atrial volume index, left atrial ejection fraction, and NT-proBNP were also significant. ... mehrCombining both clinical and AtCM markers, only CHA$_2$DS$_2$-VA score (OR: 1.95 per point, 95% CI: 1.49–2.55, P < 0.001) and P-wave area in lead II (OR: 0.99 per 100 µV·ms, 95% CI: 0.98–1.00, P = 0.031) remained independent predictors. However, this resulted in only marginal improvement in discrimination (ΔAUC: 0.03, 95% CI: 0.0001–0.0594) compared with the clinical risk factor model alone.

$\textbf{Conclusion}$
The incremental diagnostic value of AtCM markers beyond clinical risk factors for MRI-defined cerebral lesions is limited, likely reflecting the heterogeneous aetiology of stroke lesions in a general population cohort.