Succinate links atrial dysfunction and cardioembolic stroke

Neurology. 2019 Feb 19;92(8):e802-e810. doi: 10.1212/WNL.0000000000006957. Epub 2019 Jan 23.

Abstract

Objective: To determine whether altered metabolic profiles represent a link between atrial dysfunction and cardioembolic (CE) stroke, and thus whether underlying dysfunctional atrial substrate may contribute to thromboembolism risk in CE stroke.

Methods: A total of 144 metabolites were measured using liquid chromatography-tandem mass spectrometry in plasma samples collected within 9 hours of stroke onset in 367 acute stroke patients. Stroke subtype was assigned using the Causative Classification of Stroke System, and CE stroke (n = 181) was compared to non-CE stroke (n = 186). Markers of left atrial dysfunction included abnormal atrial function (P-wave terminal force in lead V1, PTFV1 >4,000 μV·ms), left atrial enlargement on echocardiography, and frank atrial fibrillation on ECG. Stroke recurrence risk was assessed using CHADS2 and CHA2DS2-VASc scores. Associations between metabolites and CE stroke, atrial dysfunction, and stroke recurrence risk were evaluated using logistic regression models.

Results: Three tricarboxylic acid metabolites-succinate (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.36-2.15, p = 1.37 × 10-6), α-ketoglutarate (OR 1.62, 95% CI 1.29-2.04, p = 1.62 × 10-5), and malate (OR 1.58, 95% CI 1.26-1.97, p = 2.57 × 10-5)-were associated with CE stroke. Succinate (OR 1.36, 95% CI 1.31-1.98, p = 1.22 × 10-6), α-ketoglutarate (OR 2.14, 95% CI 1.60-2.87, p = 2.08 × 10-8), and malate (OR 2.02, 95% CI 1.53-2.66, p = 1.60 × 10-7) were among metabolites also associated with subclinical atrial dysfunction. Of these, succinate was also associated with left atrial enlargement (OR 1.54, 95% CI 1.23-1.94, p = 1.06 × 10-4) and stroke recurrence based on dichotomized CHADS2 (OR 2.63, 95% CI 1.68-4.13, p = 3.00 × 10-6) and CHA2DS2-VASc (OR 2.43, 95% CI 1.60-3.68, p = 4.25 × 10-6) scores.

Conclusions: Metabolite profiling identified changes in succinate associated with CE stroke, atrial dysfunction, and stroke recurrence, revealing a putative underlying link between CE stroke and energy metabolism.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / blood*
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / physiopathology
  • Chromatography, Liquid
  • Echocardiography
  • Electrocardiography
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology*
  • Heart Diseases / blood
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / epidemiology
  • Heart Diseases / physiopathology
  • Humans
  • Intracranial Embolism / blood*
  • Intracranial Embolism / epidemiology
  • Ketoglutaric Acids / blood*
  • Logistic Models
  • Malates / blood*
  • Male
  • Middle Aged
  • Stroke / blood*
  • Stroke / epidemiology
  • Succinic Acid / blood*
  • Tandem Mass Spectrometry

Substances

  • Ketoglutaric Acids
  • Malates
  • malic acid
  • Succinic Acid