Supplementary Material for: Prevalence and Prognostic Value of Atrial Cardiopathy in Embolic Stroke of Undetermined Source

Introduction: We utilized data from the Third China National Stroke Registry to investigate the prevalence of atrial cardiopathy markers in patients with embolic stroke of undetermined source (ESUS) and to assess their association with death and stroke recurrence. Methods: In China, patients experiencing transient ischemic attack or ischemic stroke were recruited consecutively by the Third China National Stroke Registry. We compared atrial cardiopathy markers, such as left atrial (LA) enlargement, increased P-wave terminal force in lead V1 (PTFV1), premature atrial contractions, paroxysmal supraventricular tachycardia, advanced interatrial block, prolonged PR interval, prolonged P-wave dispersion, and prolonged P-wave duration between ESUS patients and those with small vessel disease and large artery atherosclerosis strokes. The association between these markers and the recurrence of stroke as well as mortality risk in ESUS patients was evaluated using Cox regression analysis. Results: Of 8528 ischemic stroke patients who underwent a standard diagnostic work-up, 2415 were identified as having ESUS. Multivariable analysis revealed a significant association between elevated PTFV1 and an increased risk of stroke recurrence (HR: 2.50; 95% CI: 1.53-4.09; p < 0.01) as well as mortality (HR: 3.76; 95% CI: 1.58-8.91; p < 0.01) at 1 year in patients with ESUS. Furthermore, we observed that moderate-severe LA enlargement slightly increased the risk of stroke recurrence in patients with ESUS (HR: 1.95; 95% CI: 0.90-4.26; p = 0.09). Both LA diameter (HR: 1.03; 95% CI: 1.00-1.06; p = 0.03) and the top quartile of the LA diameter index (HR: 1.56; 95% CI: 1.03-2.40; p = 0.04) were associated with stroke recurrence in patients with ESUS. Conclusions: PTFV1 was independently associated with an elevated risk of stroke recurrence and mortality in ESUS patients. Additionally, a trend toward a correlation between LA enlargement and high stroke recurrence risk after ESUS was observed.引言：本研究借助第三次中国脑卒中注册登记研究（Third China National Stroke Registry）的数据，旨在探究不明原因栓塞性卒中（embolic stroke of undetermined source, ESUS）患者的心房病（atrial cardiopathy）标志物检出率，并评估这些标志物与患者死亡及卒中复发的关联。 方法：第三次中国脑卒中注册登记研究连续纳入了中国境内发生短暂性脑缺血发作（transient ischemic attack, TIA）或缺血性卒中（ischemic stroke）的患者。本研究对比了ESUS患者与小血管病性卒中、大动脉粥样硬化性卒中患者的各类心房病标志物，包括左心房（left atrial, LA）扩大、V1导联P波终末电势（P-wave terminal force in lead V1, PTFV1）升高、房性早搏、阵发性室上性心动过速、重度房间传导阻滞、PR间期延长、P波离散度延长及P波时限延长。采用Cox回归分析（Cox regression analysis）评估ESUS患者的上述标志物与卒中复发及死亡风险的关联。 结果：在完成标准诊断检查的8528例缺血性卒中患者中，共2415例被确诊为ESUS。多变量分析显示，ESUS患者1年内的PTFV1升高与卒中复发风险升高（风险比（hazard ratio, HR）：2.50；95%置信区间（confidence interval, CI）：1.53~4.09；P<0.01）及死亡风险升高（HR：3.76；95%CI：1.58~8.91；P<0.01）存在显著关联。此外，本研究观察到中重度LA扩大可轻度增加ESUS患者的卒中复发风险（HR：1.95；95%CI：0.90~4.26；P=0.09）。LA直径（HR：1.03；95%CI：1.00~1.06；P=0.03）及LA直径指数的最高四分位数组（HR：1.56；95%CI：1.03~2.40；P=0.04）均与ESUS患者的卒中复发相关。 结论：PTFV1与ESUS患者的卒中复发及死亡风险升高独立相关。此外，本研究还观察到LA扩大与ESUS后高卒中复发风险存在潜在的相关性趋势。