Abstract WP318: Cancer and Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Clinical Trial

• DOI: 10.1161/str.56.suppl_1.wp318
• Publication Date: 2025-01-30T10:18:44Z
• Authors: Babak Navi; Mitchell Elkind; Cenai Zhang; David Tirschwell; Richard Kronmal; Jordan Elm; Joseph Broderick; David Gladstone; Hooman Kamel; W Longstreth

Background: Approximately 50% of ischemic strokes in patients with cancer are classified as cryptogenic after standard evaluation. As cancer and its treatments are associated with increased risk for atrial fibrillation (AF), the pathological substrate for AF—atrial cardiopathy—could be the underlying etiology for some of these cancer-related cryptogenic strokes. However, the relationship between cancer and atrial cardiopathy is uncertain.

Methods: We conducted a post-hoc cross-sectional analysis of baseline data collected from patients enrolled into the ARCADIA trial from 2018-2023 at 185 North American sites. Patients had to be age 45 years or older with a clinical diagnosis of cryptogenic ischemic stroke within the past 180 days and without AF of any duration. Enrolled patients consented to screening for atrial cardiopathy, the presence of which was required for randomization. Linear regression models were used to examine associations between a history of cancer and the three log-transformed atrial cardiopathy biomarkers: serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), P-wave terminal force in ECG lead V 1 (PTFV 1 ), and left atrial diameter index (LADI) on echocardiogram.

Results: Among 3,745 patients with cryptogenic stroke, 506 (13.5%) had a history of cancer. Patients with, compared to those without, a history of cancer were older (71 versus 65 years) and more often White (88% versus 74%) and non-Hispanic (94% versus 90%). Medical comorbidities were similar between groups. History of cancer was associated with higher median values of NT-proBNP (126 versus 103 pg/mL, p<0.001) and LADI (1.9 versus 1.8 cm/m 2 , p<0.001) but similar median values of PTFV 1 (3000 versus 3025, p=0.08). After adjusting for demographics and tobacco use, no association remained between history of cancer and NT-proBNP (beta-coefficient, -0.09; 95% CI, -0.20 to 0.03), PTFV 1 (beta-coefficient, -0.04; 95% CI, -0.10 to 0.02), or LADI (beta-coefficient, 0.01; 95% CI, -0.01 to 0.04).

Conclusions: In a multicenter prospective cohort of patients with cryptogenic stroke, history of cancer was not independently associated with selected biomarkers for atrial cardiopathy. These data suggest that, in the absence of apparent AF, cancer and atrial cardiopathy may not be linked in patients with stroke.