In a new study from the University of Washington, researchers found why some people who have a stroke do not also have abnormal heart rhythms, even though their hearts contain similar scar tissue.
Their results could help identify the best treatments for people who might be at risk of recurrent stroke, new heart disorders, or both.
Strokes are often caused by abnormal blood flow resulting from rapid, irregular beating in the upper chamber of the heart. This is also called atrial fibrillation (AFib).
But some people have strokes that appear to have been caused by the heart, yet there is no evidence of AFib. In fact, around 25% of strokes fall into this group—called embolic strokes of undetermined source (ESUS).
Undetectable AFib is thought to be a potential cause of ESUS, and all people who have had a stroke of undetermined source are usually monitored for AFib and started on aspirin to prevent another stroke.
If AFib is detected, stronger anti-clotting drugs would be recommended. As with all treatments, these drugs come with side effects and risks of their own, and it is important to know who really needs them.
Yet only 30% of ESUS patients ever show evidence of AFib, making it impossible for clinicians to know which patients should be treated as high-risk for AFib and which ones are better with monitoring alone.
In the study, he team developed 90 computer-based models using magnetic resonance imaging (MRI) scans from patients: 45 models were derived from patients who had a stroke of undetermined source and 45 from those who had AFib and had not yet received treatment.
They found that models from ESUS and AFib patients were equally likely to be affected by this arrhythmia initiation protocol.
This is surprising because it suggests ESUS and AFib patients have the same proverbial tinderbox of fibrotic remodeling.
The researchers believe the implication is that these stroke patients are only missing the trigger to start the fibrillation process—the spark to light the fire.
Now, the team is moving towards using this modeling approach for stroke and arrhythmia risk stratification in potentially vulnerable groups.
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The study is published in eLife. One author of the study is Savannah Bifulco.
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