History of Cancer and Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Clinical Trial

• Published in: Journal of the American Heart Association Vol. 14; no. 9; p. e040543
• Main Authors: Navi, Babak B., Elkind, Mitchell S. V., Zhang, Cenai, Tirschwell, David L., Kronmal, Richard A., Elm, Jordan, Broderick, Joseph P., Gladstone, David J., Beyeler, Morin, Kamel, Hooman, Longstreth, W. T.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 06.05.2025; Wiley
• Subjects: Aged; atrial cardiopathy; Biomarkers - blood; cancer; Cross-Sectional Studies; cryptogenic stroke; Female; Fibrinolytic Agents - therapeutic use; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Diseases - blood; Heart Diseases - complications; Heart Diseases - epidemiology; Humans; Ischemic Stroke - diagnosis; Ischemic Stroke - epidemiology; Ischemic Stroke - etiology; Ischemic Stroke - prevention & control; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Neoplasms - complications; Neoplasms - epidemiology; Original Research; Peptide Fragments - blood; Risk Assessment; risk factor; Risk Factors; atrial cardiopathy; cancer; cryptogenic stroke; risk factor
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.040543

Approximately 50% of strokes in patients with cancer are classified as cryptogenic after standard evaluation. Atrial cardiopathy could explain some cancer-related cryptogenic strokes. However, the relationship between cancer and atrial cardiopathy is uncertain. We conducted a post hoc cross-sectional analysis of baseline data collected from participants enrolled in ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke), a clinical trial conducted from 2018 to 2023 at 185 sites. The analytical cohort presented herein included patients age ≥45 years with cryptogenic ischemic stroke within the past 180 days, of whom a subset had atrial cardiopathy and were randomized into the trial. Atrial fibrillation before enrollment was exclusionary. Linear regression models examined the associations between history of cancer and the atrial cardiopathy biomarkers analyzed in ARCADIA: serum NT-proBNP (N-terminal pro-B-type natriuretic peptide), P-wave terminal force in ECG lead V , and left atrial diameter index on echocardiogram. Among 3745 patients with cryptogenic stroke, 506 (13.5%) had history of cancer. History of cancer was associated with higher median values of NT-proBNP (126 versus 103 pg/mL, <0.001) and left atrial diameter index (1.9 versus 1.8 cm/m , <0.001) but similar median values of P-wave terminal force in ECG lead V (3000 versus 3025, =0.08). After adjusting for demographics, tobacco use, and body mass index, no significant association remained between history of cancer and log-transformed NT-proBNP (standardized , -0.06 [95% CI, -0.15 to 0.02]), P-wave terminal force in ECG lead V (standardized , -0.02 [95% CI, -0.11 to 0.08]), or left atrial diameter index (standardized , 0.06 [95% CI, -0.05 to 0.16]). In a multicenter, prospective, cryptogenic stroke cohort, history of cancer was not associated with selected biomarkers for atrial cardiopathy. URL: https://www.ClinicalTrials.gov; Unique Identifier: NCT03192215.