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Abstract Details

Left Atrial Enlargement and Reduced Ejection Fraction are Independently Associated with Cardiomebolic Stroke
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)

Current guidelines for secondary stroke prevention in patients with atrial fibrillation (Afib) include anticoagulation; however, studies have failed to prove the benefit of anticoagulantion over antiplatelets in patients with heart failure without evidence of Afib. Studies have shown that heart failure and LAE are independent risk factors for stroke.  This would raise the question whether patients with reduced EF and LAE would benefit from anticoagulation. 

To evaluate the association between left atrial enlargement (LAE) and reduced ejection fraction (EF) with cardioembolic stroke 


Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016-2017 were included based on the following criteria: age >18 and availability of echocardiogram. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. Ejection fraction was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51%(male), 41-53% (female), moderately abnormal: 30-40% (same in both genders), and severely abnormal: <30% (same in both genders). Other variables included: left atrial volume size categorized into normal (≤34 ml/m2) vs.  enlarged (≥35 ml/m2), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of Afib. 

Two hundred eighteen patients had cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and LAE, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The odds of cardioembolic stroke were 8.8 times higher in patients with severely reduced EF compared to normal EF and 2.4 times higher in patients with LAE compared to normal left atrial size. The number of patients with reduced EF and LAE were higher in patients with cardioembolic stroke (P<0.001).

Our results showed an independent association between LAE and severely reduced EF with cardioembolic stroke warranting further studies to determine the appropriate treatment for secondary stroke prevention.

Maryam Hosseini, MD
Dr. Hosseini has nothing to disclose.
Shadi Milani, DO Dr. Milani has nothing to disclose.
Mohammad Shafie, MD (Department of Neurology - University of California, Irvine) Dr. Shafie has nothing to disclose.