Correlation between atrial cardiomyopathy and total burden of cerebral small vessel disease in patients with acute ischemic stroke

Background Atrial cardiomyopathy (ACM) and cerebral small vessel disease (CSVD) share common risk factors (e.g., hypertension, diabetes, dyslipidemia, aging) and pathophysiological mechanisms (e.g., inflammatory response, oxidative stress). Objective This study aimed to investigate the relationship between ACM and the total CSVD burden in patients with acute ischemic stroke (AIS). Methods We retrospectively enrolled eligible hospitalized AIS patients. Imaging markers were measured based on MRI data, including periventricular and deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), lacunes, cerebral microbleeds (CMBs), and brain atrophy. The total CSVD burden was calculated using the Wardlaw score. A P-wave terminal force in lead V1 (PTFV1) > 5,000 μV·ms was used to define atrial cardiomegaly (ACM), and a PTFV1 ≤ 5,000 μV·ms was adopted to define non-atrial cardiomegaly (NACM). Univariate and multivariate ordinal logistic regression analyses estimated the correlation between ACM and total CSVD burden. Results Among 323 enrolled patients (mean age 67.67 years, 63.7% male), 83 were classified as ACM. Patients with ACM had significantly higher total Wardlaw scores (OR = 1.79, 95% CI = 1.07–3.02, p = 0.026). Age, hypertension, and NIHSS score were also independent risk factors for increased total burden [OR = 1.05 (95% CI = 1.02–1.07, p < 0.001), 2.09 (95% CI = 1.29–3.42, p = 0.003), and 1.13 (95% CI = 1.03–1.24, p = 0.009), respectively]. Conclusion This study found a suggestive association between ACM and total CSVD burden in AIS patients, underscoring the importance of assessing ACM for evaluating CSVD risk factors in this patient population.