ABSTRACT NUMBER: ESOC2026A1249 ATRIAL CARDIOPATHY IN EMBOLIC STROKES OF UNDETERMINED SOURCE

Abstract Background and aims Atrial cardiopathy (AC) is a major contributor to embolic ischemic stroke. This study aims to identify AC and its markers for early detection and reduction of stroke recurrence. Methods We conducted a prospective study including patients hospitalized for ischemic stroke classified as ESUS in the Neurology Department of Monastir over a 3-year period. We evaluated several electrocardiographic, echocardiographic, and biological markers, including the P-terminal force in lead V1 (PTFV1), P-wave dispersion, left atrial diameter, and BNP levels. Results We included 66 ESUS patients. Atrial cardiopathy (AC) was the most frequent embolic source, affecting 71.2%, defined by at least one of: PTFV1 > 5000 μV/ms (31.8%), P-wave dispersion > 40 ms (43.9%), left atrial dilation (LAD) (24.2%), or BNP > 35 pg/mL (26.6%). Among those with LAD, 3 had spontaneous intra-atrial contrast, and atrial hyperexcitability was reported in 21.2%. During follow-up, atrial fibrillation (AF) was detected in 18.2% of patients, mainly on a second 24-hour Holter performed after 2 ± 1.2 months, the first being negative. Additionally, 4.5% of AF cases were diagnosed on ECG during follow-up. Newly detected AF was significantly associated with AC (p = 0.044) and with elevated PTFV1 (p = 0.01), atrial hyperexcitability (p = 0.007), and LAD (p = 0.0023). Conclusions AC is a common cause of ESUS. Assessment of electrocardiographic, echocardiographic, and biological markers allows identification of patients at risk of AF, thereby facilitating its detection and guiding treatment. Conflict of interest Yosr Boubaker. nothing to disclose