Left atrial dilatation is associated with severe ischemic stroke in men with non-valvular atrial fibrillation

Abstract

Background: Increased left atrial volume is an independent predictive factor of first ischemic stroke and other cardiovascular events in patients with non-valvular atrial fibrillation (NVAF). However, correlations between left atrial dilatation and ischemic stroke severity or ischemic lesion pattern have not been previously reported. The aim of this study was to evaluate whether left atrial enlargement is associated with worse initial stroke severity and lesion patterns.

Methods: Consecutive patients with acute ischemic stroke and NVAF who were anticoagulation-naïve were enrolled, and all patients were stratified into moderate-to-severe and mild neurologic deficit groups using the National Institutes of Health Stroke Scale (NIHSS) at admission. Left atrial diameter (LAD) and left atrial volume index (LAVI), stratified by sex, were compared between the two groups. Ischemic lesion patterns were also investigated in relation to the LAD and LAVI.

Results: A total of 98 patients were enrolled. Of these, 37 were classified as having a moderate-to-severe neurologic deficit (NIHSS≥10), and 61 were classified as having a mild neurologic deficit at admission. After adjusting for confounding factors, increases in LAD and LAVI were significantly associated with moderate-to-severe neurologic deficits, especially in men. Men in the upper two tertiles of LAD and LAVI had more severe stroke symptoms when compared with participants in the lowest tertile. In partial correlation coefficient analysis adjusted for CHA2DS2-VASc risk factors, LAD and LAVI in men were positively correlated with NIHSS score (r=0.553; p<0.001 and r=0.393; p=0.004, respectively), and LAVI in all enrolled patients was significantly correlated with NIHSS score (r=0.215; p=0.045).

Conclusion: Increased LAD and LAVI were associated with worse initial neurologic deficits in anticoagulation-naïve patients with acute ischemic stroke and NVAF, especially in men. Recognition of the atrial abnormalities and effective anticoagulation may reduce thrombogenesis in NVAF.

Keywords: Atrial fibrillation; Ischemic stroke; Left atrial volume; Non-valvular; Severity.