Cancer and Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Clinical Trial
Abstract Body: 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 V1 (PTFV1), 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/m2, p<0.001) but similar median values of PTFV1 (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), PTFV1 (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.
Navi, Babak
( Weill Cornell Medicine
, New York
, New York
, United States
)
Longstreth, W
( Harborview Medical Center
, Seattle
, Washington
, United States
)
Elkind, Mitchell
( American Heart Association
, New York
, New York
, United States
)
Zhang, Cenai
( Weill Cornell Medicine
, New York
, New York
, United States
)
Tirschwell, David
( HARBORVIEW MEDICAL CENTER
, Seattle
, Washington
, United States
)
Kronmal, Richard
( University of Washington
, Seattle
, Washington
, United States
)
Elm, Jordan
( MEDICAL UNIVERSITY SOUTH CAROLINA
, Charleston
, South Carolina
, United States
)
Broderick, Joseph
( UNIVERSITY CINCINNATI
, Cincinnati
, Ohio
, United States
)
Gladstone, David
( University of Toronto
, Toronto
, Ontario
, Canada
)
Kamel, Hooman
( Weill Cornell Medicine
, New York
, New York
, United States
)
Author Disclosures:
Babak Navi:DO have relevant financial relationships
;
Independent Contractor:MindRhythm, Inc.:Past (completed)
| W Longstreth:DO NOT have relevant financial relationships
| Mitchell Elkind:DO have relevant financial relationships
;
Research Funding (PI or named investigator):Roche:Past (completed)
; Employee:American Heart Association:Active (exists now)
; Speaker:Atria Academy of Science and Medicine:Past (completed)
; Research Funding (PI or named investigator):BMS-Pfizer Alliance for Eliquis:Past (completed)
| Cenai Zhang:DO NOT have relevant financial relationships
| David Tirschwell:DO have relevant financial relationships
;
Consultant:AbbVie:Past (completed)
; Research Funding (PI or named investigator):Abbott:Active (exists now)
| Richard Kronmal:DO NOT have relevant financial relationships
| Jordan Elm:DO NOT have relevant financial relationships
| Joseph Broderick:DO have relevant financial relationships
;
Consultant:Roche:Active (exists now)
; Other (please indicate in the box next to the company name):Novo Nordisk - study medication and after-hour call support for ongoing NIH funded trial:Active (exists now)
; Other (please indicate in the box next to the company name):Kroger - Pharmacy Committee:Active (exists now)
; Consultant:Brainsgate:Past (completed)
; Consultant:Basking Bioscience:Active (exists now)
; Researcher:Genentech:Past (completed)
| David Gladstone:No Answer
| Hooman Kamel:DO have relevant financial relationships
;
Other (please indicate in the box next to the company name):Financial disclosures for Hooman Kamel: a PI role in the ARCADIA trial, which received in-kind study drug from the BMS-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics; a Deputy Editor role for JAMA Neurology; clinical trial steering/executive committee roles for the STROKE-AF (Medtronic), LIBREXIA-AF (Janssen), and LAAOS-4 (Boston Scientific) trials; consulting or endpoint adjudication committee roles for AbbVie, AstraZeneca, Boehringer Ingelheim, and Novo Nordisk; and household ownership interests in TETMedical, Spectrum Plastics Group, and Ascential Technologies.:Active (exists now)
