# Defining the role of Atrial Cardiopathy and Subclinical Cardiac Disease in Acute Ischemic Stroke

> **NIH NIH K23** · JOHNS HOPKINS UNIVERSITY · 2024 · $193,860

## Abstract

PROJECT SUMMARY
Cardioembolic stroke (CES) is costly, not only financially, but also personally to patients and their families, with
high rates of recurrence and the highest rate of mortality when compared to strokes of other subtypes. A
critical barrier to progress in the field is that currently, the only evidence-based treatment strategy for CES is
initiation of anticoagulation (AC) when an atrial tachyarrhythmia, such as atrial fibrillation (AF), is identified
post-stroke. However, AF may simply reflect one marker of underlying left atrial (LA) pathology with accruing
evidence suggesting that other changes in cardiac structure and function, such as that which occurs at the
endothelial level, is responsible for thrombosis irrespective of manifestation of AF. Currently, there is no known
means to correctly identity other cardiac pathologies that increase risk for stroke, outside of identification of an
arrhythmia. An ongoing clinical trial (ARCADIA) has offered one definition of atrial cardiopathy, but whether this
definition is sufficient is unknown. Additionally, how such markers once identified impact patient care and long-
term outcomes is also unknown. The purpose of this proposal is to characterize cardiac structure and function
in patients with acute ischemic stroke, by (A) evaluating associations between specific cardiac anatomical
markers and patient long-term functional outcomes (Aim 1) and (B) utilizing advanced imaging techniques to
increase the precision by which such cardiac anatomy is identified to enable prediction of CES (Aim 2).
Defining these currently unknown mechanisms in patients with CES, but without AF will allow for the
development of effective strategies aimed at mitigating recurrent stroke and poor patient outcomes. For Aim 1,
I will follow a previously funded, prospectively enrolled cohort of acute ischemic stroke patients with
echocardiography with strain (sTTE) for up to 5 years post-stroke to assess 3 different measures of patient
outcome: 90-day modified Rankin Scale (mRS), readmission rates and recurrent stroke. I hypothesize that
specific sTTE markers of LA dysfunction will be associated with worse outcomes. For Aim 2, I will then recruit a
new cohort of acute ischemic stroke patients without AF and utilize more advanced imaging techniques
(computerized coronary tomography angiography, C-CTA) to define the association of specific LA markers with
stroke subtype, hypothesizing that particular C-CTA parameters will be associated with CES and that these
markers will improve prediction of stroke subtype beyond sTTE alone, and beyond a current trial definition of
atrial cardiopathy (ARCADIA). Understanding the relationship between markers of LA function and stroke
subtype as well as post-stroke outcomes important to the patient will impact clinical practice and aid future
research. This science will be paired with critical training in advanced cardiovascular imaging methods, risk
prediction and cohort and clinical tri...

## Key facts

- **NIH application ID:** 10897041
- **Project number:** 5K23NS112459-05
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Michelle C. Johansen
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $193,860
- **Award type:** 5
- **Project period:** 2020-08-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10897041

## Citation

> US National Institutes of Health, RePORTER application 10897041, Defining the role of Atrial Cardiopathy and Subclinical Cardiac Disease in Acute Ischemic Stroke (5K23NS112459-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10897041. Licensed CC0.

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