{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:32:01Z","timestamp":1791401521034,"version":"4.3.3"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270329"],"award-info":[{"award-number":["82270329"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Metabolic syndrome (MetS) and atrial cardiomyopathy (AtCM) are recognized as risk factors for cardiovascular disease, including stroke. We aimed to determine the combined impact of MetS and AtCM on stroke mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were selected from the Third National Health and Nutrition Examination (NHANES III) Survey. MetS was defined according to the Adult Treatment Panel III, while AtCM was defined as deep terminal negativity of the P wave in V1 (DTNPV1). Survey\u2010weighted Firth penalized Cox analysis was performed to determine the adjusted HRs and 95% CIs of stroke mortality by MetS\u2010AtCM status, including metabolically healthy without AtCM (MHNA; reference), metabolically unhealthy without AtCM (MUNA), metabolically healthy with AtCM (MHA), metabolically unhealthy with AtCM (MUA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 4315 participants were included in the analysis. Throughout the follow\u2010up, the rates of stroke mortality increased across the MetS\u2010AtCM status categories: 1.56, 2.78, 4.68, and 8.24 per 1000 person\u2010years in MHNA, MUNA, MHA, and MUA groups, respectively. Compared to the MHNA participants, MUA were at a higher risk of stroke mortality (HR\u2009=\u20093.33, 95% CI 1.24\u20138.94,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018). Stroke mortality showed a non\u2010significant upward trend in both MUNA (HR\u2009=\u20091.57, 95% CI 0.96\u20132.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.074) and MHA (HR\u2009=\u20091.61, 95% CI 0.52\u20135.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.401) groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest a potential joint association of MetS and AtCM on stroke mortality. Further RCTs are warranted to evaluate the efficacy of anticoagulation in preventing ischemic stroke and reducing stroke mortality among individuals with both MetS and AtCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anec.70148","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T07:20:34Z","timestamp":1767165634000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Metabolic Syndrome and Atrial Cardiomyopathy on the Risk of Stroke Mortality in the General Population"],"prefix":"10.1111","volume":"31","author":[{"given":"Yaodongqin","family":"Xia","sequence":"first","affiliation":[{"name":"Division of Cardiology The First Affiliated Hospital With Nanjing Medical University  Nanjing China"},{"name":"Department of Critical Care Medicine Kunshan Hospital of Chinese Medicine  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kunshan Hospital of Chinese Medicine  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-486X","authenticated-orcid":false,"given":"Minglong","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology The First Affiliated Hospital With Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8755-6965","authenticated-orcid":false,"given":"Mingfang","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Cardiology The First Affiliated Hospital With Nanjing Medical University  Nanjing China"},{"name":"Division of Cardiology The Affiliated Suqian First People's Hospital of Nanjing Medical University  Suqian China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019876543"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933\u2010021\u201001215\u20108"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH07\u201011\u20100682"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.02.005"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.121.010435"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2013.01.001"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.5551\/jat.52241"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(05)66378\u20107"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/17474930211065917"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.05.028"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010023\u201011693\u20103"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.06.038"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006717"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12739"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493018799981"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.2217\/fca.15.22"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14093250"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15101207"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.034388"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/hs1201.100209"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000204354.06965.44"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000437068.30550.cf"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010150\u20109\u2010200905050\u201000006"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2022.04.019"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933\u2010021\u201001220\u2010x"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22\u20101638"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017226"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.05.034"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2019.12.015"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000108926.04022.0C"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475\u20102840\u201012\u2010152"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaf014"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacbts.2019.05.005"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12969"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(19)30078\u2010X"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.3872"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12453"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.12.030"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.744466"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1159\/000368754"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012415"}],"container-title":["Annals of Noninvasive Electrocardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.70148","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anec.70148","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.70148","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T17:25:18Z","timestamp":1769534718000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/anec.70148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/anec.70148"],"URL":"https:\/\/doi.org\/10.1111\/anec.70148","archive":["Portico"],"relation":{},"ISSN":["1082-720X","1542-474X"],"issn-type":[{"value":"1082-720X","type":"print"},{"value":"1542-474X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]},"assertion":[{"value":"2025-05-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70148"}}