{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:47:47Z","timestamp":1792100867236,"version":"4.4.0"},"reference-count":46,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Dilated cardiomyopathy (DCM) is a major cause of heart failure and arrhythmic mortality; yet, its association with cerebrovascular events, particularly in the absence of atrial fibrillation (AF), remains insufficiently explored. Purpose: This study aimed to determine the prevalence, mechanisms, and anatomical distribution of stroke in patients with DCM and to assess the role of AF and structural remodeling in stroke risk. Methods: We retrospectively analyzed 471 patients who died with DCM at the Emergency County Clinical Hospital of Bihor between 1 January 2022 and 31 December 2024. Clinical records, neuroimaging, autopsy reports, and histopathological data were reviewed. Stroke subtypes were classified according to TOAST criteria (large artery atherosclerosis, cardioembolic, small vessel disease, other determined, undetermined) and hemorrhagic categories (intracerebral, subarachnoid). Demographic, echocardiographic, and comorbidity data were compared between patients with and without cerebrovascular events. Results: Of 471 patients with DCM, 45 (9.6%) had concomitant stroke: pure ischemic in 32 (71.1%), 7 (15.6%) showed ischemic with hemorrhagic transformation, and primary hemorrhagic in 6 (13.3%). The parietal lobe was most frequently affected. AF was present in 26 patients (57.8%) and was significantly associated with ischemic stroke (p = 0.004), though embolic strokes also occurred in sinus rhythm. Patients with stroke had significantly lower left ventricular ejection fraction (28.0 \u00b1 13.7% vs. 34.0 \u00b1 11.2%, p = 0.007) and larger atrial dimensions. Histopathological findings confirmed acute and chronic ischemic injury patterns, including \u201cred neurons,\u201d white matter vacuolization, and gliotic scarring. Conclusions: Stroke is a frequent and often underdiagnosed complication in DCM, predominantly ischemic and embolic in nature. Importantly, embolic events were observed even in patients without AF, suggesting that atrial remodeling in DCM may independently predispose to cerebrovascular risk. These results underscore the need for refined preventive strategies, including careful atrial assessment and exploration of whether anticoagulation may benefit selected high-risk DCM patients without AF, a question that requires confirmation in prospective trials. Potential embolic sources in DCM include atrial cardiopathy and left ventricular thrombus in the setting of severe systolic dysfunction; therefore, careful ventricular as well as atrial assessment is warranted in high-risk DCM.<\/jats:p>","DOI":"10.3390\/diagnostics15182287","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T19:16:17Z","timestamp":1757445377000},"page":"2287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Stroke in Dilated Cardiomyopathy: An Autopsy-Based Study of Mechanisms, Topography, and Clinical Implications"],"prefix":"10.3390","volume":"15","author":[{"given":"Otilia","family":"\u021aica","sequence":"first","affiliation":[{"name":"Cardiology Clinic, Emergency County Clinical Hospital of Bihor, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Sab\u0103u","sequence":"additional","affiliation":[{"name":"Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"},{"name":"Neurology Clinic, Emergency County Clinical Hospital of Bihor, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Venter","sequence":"additional","affiliation":[{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"},{"name":"Radiology Clinic, Emergency County Clinical Hospital of Bihor, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina","family":"Beiu\u0219anu","sequence":"additional","affiliation":[{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihail","family":"Berechet","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Huniadi","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea Ioan","family":"\u0218andor","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-6836","authenticated-orcid":false,"given":"Ovidiu","family":"\u021aica","sequence":"additional","affiliation":[{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"},{"name":"Pathology Department, Emergency County Clinical Hospital of Bihor, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0140-6736(16)31713-5","article-title":"Dilated cardiomyopathy","volume":"390","author":"Weintraub","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Barkhudaryan, A., Doehner, W., and Scherbakov, N. (2021). Ischemic Stroke and Heart Failure: Facts and Numbers. An Update. J. Clin. Med., 10.","DOI":"10.3390\/jcm10051146"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1161\/CIRCRESAHA.116.309396","article-title":"Dilated Cardiomyopathy: Genetic Determinants and Mechanisms","volume":"121","author":"McNally","year":"2017","journal-title":"Circ. Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Schultheiss, H.P., Fairweather, D., Caforio, A.L.P., Escher, F., Hershberger, R.E., Lipshultz, S.E., Liu, P.P., Matsumori, A., Mazzanti, A., and McMurray, J. (2019). Dilated cardiomyopathy. Nat. Rev. Dis. Primers, 5.","DOI":"10.1038\/s41572-019-0084-1"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"\u021aica, O., \u021aica, O., Bunting, K.V., deBono, J., Gkoutos, G.V., Popescu, M.I., and Kotecha, D. (2022). Post-mortem examination of high mortality in patients with heart failure and atrial fibrillation. BMC Med., 20.","DOI":"10.1186\/s12916-022-02533-8"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"\u0162ica, O., Khamboo, W., and Kotecha, D. (2022). Breaking the Cycle of Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation. Card. Fail. Rev., 8.","DOI":"10.15420\/cfr.2022.03"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1159\/000533880","article-title":"Circulating Neuropeptide Y May Be a Biomarker for Diagnosing Atrial Fibrillation","volume":"148","author":"Jelavic","year":"2023","journal-title":"Cardiology"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lip, G.Y.H., Proietti, M., Potpara, T., Mansour, M., Savelieva, I., Tse, H.F., Goette, A., Camm, A.J., Blomstrom-Lundqvist, C., and Gupta, D. (2023). Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal. Europace, 25.","DOI":"10.1093\/europace\/euad226"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Buckley, B.J.R., Harrison, S.L., Gupta, D., Fazio-Eynullayeva, E., Underhill, P., and Lip, G.Y.H. (2021). Atrial Fibrillation in Patients with Cardiomyopathy: Prevalence and Clinical Outcomes from Real-World Data. J. Am. Heart Assoc., 10.","DOI":"10.1161\/JAHA.121.021970"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/ehjdh\/ztac046","article-title":"Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomized trial","volume":"3","author":"Wang","year":"2022","journal-title":"Eur. Heart J. Digit. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3707","DOI":"10.1093\/eurheartj\/ehae539","article-title":"Gender and contemporary risk of adverse events in atrial fibrillation","volume":"45","author":"Champsi","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fan, Z., Wu, C., Wang, C., Liu, C., Fang, L., Ma, L., Zou, W., Yuan, B., Ji, Z., and Cai, B. (2024). Impact of Concurrent Ischaemic Stroke on Unfavourable Outcomes in Men and Women with Dilated Cardiomyopathy. Rev. Cardiovasc. Med., 25.","DOI":"10.31083\/j.rcm2506215"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Shitole, S.G., Heckbert, S.R., Marcus, G.M., Shah, S.J., Sotoodehnia, N., Walston, J.D., Reiner, A.P., Tracy, R.P., Psaty, B.M., and Kizer, J.R. (2024). Assessment of Inflammatory Biomarkers and Incident Atrial Fibrillation in Older Adults. J. Am. Heart Assoc., 13.","DOI":"10.1161\/JAHA.124.035710"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC Guidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jurcut, R., Barriales-Villa, R., Biagini, E., Garcia-Pavia, P., Olivotto, I., Protonotarios, A., Arbustini, E., Mogensen, J., Elliott, P., and Arbelo, E. (2024). Key priorities for the implementation of the 2023 ESC Guidelines for the Management of Cardiomyopathies in low resource settings. Eur. Heart J. Qual. Care Clin. Outcomes, qcae103.","DOI":"10.1093\/ehjqcco\/qcae103"},{"key":"ref_16","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e579","DOI":"10.1161\/CIR.0000000000000455","article-title":"Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement from the American Heart Association","volume":"134","author":"Bozkurt","year":"2016","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jama.2024.22451","article-title":"Atrial Fibrillation: A Review","volume":"333","author":"Ko","year":"2025","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0072-9752(08)01905-2","article-title":"Neuropathology of ischemic brain injury","volume":"92","author":"Ogata","year":"2008","journal-title":"Handb. Clin. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Weerts, J., \u021aica, O., Aranyo, J., Basile, C., Borizanova-Petkova, A., Borovac, J.A., Camilli, M., Eichenlaub, M., Fiori, E., and Van Loon, T. (2025). Atrial cardiomyopathy: From healthy atria to atrial failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur. J. Heart Fail.","DOI":"10.1002\/ejhf.3782"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"\u021aica, O., and \u021aica, O. (2025). Anemia in Heart Failure: Diagnostic Insights and Management Patterns Across Ejection Fraction Phenotypes. Diagnostics, 15.","DOI":"10.3390\/diagnostics15162079"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1177\/23969873241276358","article-title":"Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial","volume":"10","author":"Kamel","year":"2025","journal-title":"Eur. Stroke J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1136\/svn-2023-002447","article-title":"Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study","volume":"9","author":"Didier","year":"2024","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Karakasis, P., Vlachakis, P.K., Theofilis, P., Ktenopoulos, N., Patoulias, D., Fyntanidou, B., Antoniadis, A.P., and Fragakis, N. (2025). Atrial Cardiomyopathy in Atrial Fibrillation: A Multimodal Diagnostic Framework. Diagnostics, 15.","DOI":"10.3390\/diagnostics15101207"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jjcc.2024.07.006","article-title":"Left atrium as key player and essential biomarker in heart failure","volume":"85","author":"Inoue","year":"2025","journal-title":"J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kov\u00e1cs, K.B., Bencs, V., Hud\u00e1k, L., Ol\u00e1h, L., and Csiba, L. (2023). Hemorrhagic Transformation of Ischemic Strokes. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241814067"},{"key":"ref_27","first-page":"327","article-title":"Histopathological changes in acute ischemic stroke","volume":"50","author":"Pirici","year":"2009","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1093\/eurheartj\/ehac220","article-title":"Autopsy in the era of advanced cardiovascular imaging","volume":"43","author":"Basso","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Liu, B., Bunting, K.V., Brind, D., Thorley, A., Karwath, A., Lu, W., Zhou, D., Wang, X., and Mobley, A.R. (2024). Development of automated neural network prediction for echocardiographic left ventricular ejection fraction. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1354070"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Mauriello, A., Correra, A., Ascrizzi, A., Del Vecchio, G.E., Benfari, G., Ilardi, F., Lisi, M., Malagoli, A., Mandoli, G.E., and Pastore, M.C. (2024). Relationship Between Left Atrial Strain and Atrial Fibrillation: The Role of Stress Echocardiography. Diagnostics, 15.","DOI":"10.20944\/preprints202412.0234.v1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rienstra, M., Tzeis, S., Bunting, K.V., Caso, V., Crijns, H., De Potter, T.J.R., Sanders, P., Svennberg, E., Casado-Arroyo, R., and Dwight, J. (2024). Spotlight on the 2024 ESC\/EACTS management of atrial fibrillation guidelines: 10 novel key aspects. Europace, 26.","DOI":"10.1093\/europace\/euae298"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/ehjcvp\/pvaf040","article-title":"Prevention of atrial fibrillation with SGLT2 inhibitors across the spectrum of cardiovascular disorders: A meta-analysis of randomised controlled trials","volume":"11","author":"Fedele","year":"2025","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Armillotta, M., Angeli, F., Paolisso, P., Belmonte, M., Raschi, E., Di Dalmazi, G., Amicone, S., Canton, L., Fedele, D., and Suma, N. (2025). Cardiovascular therapeutic targets of sodium-glucose co-transporter 2 (SGLT2) inhibitors beyond heart failure. Pharmacol. Ther., 270.","DOI":"10.1016\/j.pharmthera.2025.108861"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1159\/000531467","article-title":"Are the Four Pillars the Ideal Treatment for the Elderly?","volume":"148","author":"Teodorovich","year":"2023","journal-title":"Cardiology"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Velt, M.J.H., van Gelder, I.C., Crijns, H.J.G.M., Rienstra, M., and Mulder, B.A. (2025). Duration of atrial fibrillation and cardiac biomarkers are associated with cardiovascular outcomes in early permanent atrial fibrillation: Data from the RACE II study. Int. J. Cardiol., 439.","DOI":"10.1016\/j.ijcard.2025.133669"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/europace\/euac066","article-title":"Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: A position paper by EHRA\/HRS\/LAHRS\/APHRS","volume":"24","author":"Boersma","year":"2022","journal-title":"Europace"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3593","DOI":"10.1093\/eurheartj\/ehz427","article-title":"A comprehensive analysis of the effects of rivaroxaban on stroke or transient ischaemic attack in patients with heart failure, coronary artery disease, and sinus rhythm: The COMMANDER HF trial","volume":"40","author":"Mehra","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"\u021aica, O., and \u021aica, O. (2025). Molecular Diagnostics in Heart Failure: From Biomarkers to Personalized Medicine. Diagnostics, 15.","DOI":"10.3390\/diagnostics15141807"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/j.jacc.2024.07.023","article-title":"Heart Failure Risk Assessment Using Biomarkers in Patients with Atrial Fibrillation: Analysis from COMBINE-AF","volume":"84","author":"Haller","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Karuna, N., Tonry, C., Ledwidge, M., Glezeva, N., Gallagher, J., McDonald, K., and Watson, C.J. (2025). Proteomic-based biomarker discovery reveals panels of diagnostic biomarkers for early identification of heart failure subtypes. J. Transl. Med., 23.","DOI":"10.1186\/s12967-025-06563-7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"50","DOI":"10.15420\/cfr.2018.27.2","article-title":"Biomarkers in Routine Heart Failure Clinical Care","volume":"5","author":"Nadar","year":"2019","journal-title":"Card. Fail. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Alzaabi, M.A., Abdelsalam, A., Alhammadi, M., Bani Hani, H., Almheiri, A., Al Matrooshi, N., and Al Zaman, K. (2024). Evaluating Biomarkers as Tools for Early Detection and Prognosis of Heart Failure: A Comprehensive Review. Card. Fail. Rev., 10.","DOI":"10.15420\/cfr.2023.24"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ohnewein, B., Shomanova, Z., Jirak, P., Paar, V., Topf, A., Pylypenko, L., Sch\u00e4binger, M., Volg, F., Hoppe, U.C., and Pistulli, R. (2025). Dynamics of the Novel Cardiac Biomarkers sST2, H-FABP, GDF-15 and suPAR in HFrEF Patients Undergoing Heart Failure Therapy, a Pilot Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14165668"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Daise, M.A., Maule, G., Ismail, M., Alqudah, Q., Mojaddedi, S., Obeidat, O., and Ismail, K. (2025). Atrial cardiomyopathy: Current clinical perspectives and future insights. Future Cardiol., 1\u20139.","DOI":"10.1080\/14796678.2025.2548159"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Oancea, A.-F., Morariu, P.C., Godun, M., Dobreanu, S.D., Jigoranu, A., Mihnea, M., Iosep, D., Buburuz, A.M., Miftode, R.S., and Floria, D.-E. (2025). Galectin-3 and Pentraxin-3 as Potential Biomarkers in Chronic Coronary Syndrome and Atrial Fibrillation: Insights from a 131-Patient Cohort. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202504.2195.v1"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2287\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:42:53Z","timestamp":1760035373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":46,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182287"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182287","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}