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ARCADIA Trial Will Test Link Between Stroke and a Common Heart Condition

NYP.org
August 15, 2017

New York - A new clinical trial led by investigators at NewYork-Presbyterian, Columbia University Medical Center (CUMC) and Weill Cornell Medicine aims to identify and treat what may be a common underlying cause of recurrent strokes. ARCADIA, a multicenter phase III trial, will study the role of abnormalities in the structure and function of the heart’s left atrium, or atrial cardiopathy, in stroke patients, and test a medication that could prevent them from experiencing recurrent strokes.

A common heart rhythm disorder called atrial fibrillation is currently thought to be required for blood clots to form in the left atrium, which can, in turn, cause strokes. When atrial fibrillation is present, physicians administer blood-thinning drugs such as apixaban that are effective in preventing recurrent strokes.

However, as many as one-third of strokes are classified as “cryptogenic,” meaning they have no known origin. These patients are generally advised to take an aspirin daily. There is evidence that atrial cardiopathy can cause clots to travel to the brain in the same way as atrial fibrillation, and thus could be responsible for many of these cryptogenic strokes.

"We strongly suspect based on several studies we have performed that atrial cardiopathy may be a common cause of stroke among patients whose strokes are otherwise unexplained," said Dr. Mitchell Elkind, attending neurologist on the Stroke Service at NewYork-Presbyterian/Columbia University Irving Medical Center, professor of neurology and epidemiology in the Gertrude H. Sergievsky Center at CUMC and one of the lead investigators of the trial. "This trial will provide us with important insight into whether atrial cardiopathy really is an important risk factor for stroke, and could also lead to an effective treatment for many patients." [read more]