Abstract
BACKGROUND: Atrial fibrillation (AF) increases the risk and severity of ischemic stroke, particularly in large vessel occlusion (LVO) cases. Atrial cardiomyopathy (AtCM) severity may explain why some AF patients suffer LVO while others develop distal cardioembolic strokes. This study aimed to investigate whether AtCM markers detected on acute brain-cardiac CT are associated with LVO in AF patients presenting with ischemic stroke. METHODS: We analyzed 619 ischemic stroke patients admitted to Dijon University Hospital from November 2018 to March 2021. The cohort was divided based on the presence of LVO. Cardiac CT assessed left atrium volume (LAV), left atrial thrombus, and epicardial adipose tissue. Patients were grouped by LVO status. RESULTS: Of the 248 patients with acute stroke and AF, 138 (56%) had LVO. LVO patients had higher NIHSS scores (11 vs. 3, p < 0.001) and more frequent use of IV thrombolysis (27.7% vs. 12.3%, p = 0.030). Cardiac CT showed higher LAV in LVO patients (112.0 ± 43.0 cm(3) vs. 100.1 ± 39.0 cm(3), p = 0.026). Multivariable analysis identified female sex (OR 1.98, 95% CI 1.12-3.50, p = 0.018) and LAV > 90 mL (OR 2.02, 95% CI 1.18-3.46, p = 0.010) as independent predictors of LVO. CONCLUSIONS: Larger LAV and female sex independently predict LVO in AF patients, highlighting AtCM's role in stroke pathophysiology. Further research is needed to explore prevention strategies for high-risk AF patients.