What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=1051). Intervention: Left atrial epicardial adipose tissue (LA-EAT) volume index. Primary outcome: Atrial fibrillation detected after stroke (AFDAS) (OR 1.07, 95% CI 1.04-1.09, p=<0.001).

What question did this study set out to answer?

This study investigates the relationship between left atrial epicardial adipose tissue and atrial fibrillation detected after stroke.

June 19, 2026Open Access

LA epicardial adipose tissue is associated with atrial fibrillation detected after stroke

Q: What are the key findings of this study?

Higher left atrial epicardial adipose tissue volume index was independently associated with an increased risk of atrial fibrillation detected after stroke (OR 1.07).

Q: What question did this study set out to answer?

This study investigates the relationship between left atrial epicardial adipose tissue and atrial fibrillation detected after stroke.

LXLiangCheng XuThe First People’s Hospital of Lianyungang JYJiayu YinSoochow University ZTZhiwen TaoJiangsu Province Hospital

Key Result

Higher left atrial epicardial adipose tissue volume index was independently associated with an increased risk of atrial fibrillation detected after stroke (OR 1.07).

Key Points

This study investigates the relationship between left atrial epicardial adipose tissue and atrial fibrillation detected after stroke.
Single-center retrospective cohort study of 1051 patients with MRI-confirmed acute ischemic stroke.
Patients underwent contrast-enhanced CT angiography; new-onset AF was monitored during hospitalization.
Multivariate logistic regression analyzed the association between LA-EAT and AFDAS.
AFDAS was observed in 78 out of 1051 patients (7.4%).
LA-EAT volume index showed a moderate correlation with LAVI (r = 0.481, p < 0.001).
LA-EAT volume index was independently associated with AFDAS (OR = 1.07; 95% CI 1.04–1.09; p < 0.001).

Study Design

Type

Cohort (n=1,051)

Multicenter

Structured PICO

Is left atrial epicardial adipose tissue (LA-EAT) volume associated with the development of atrial fibrillation detected after stroke in patients with acute ischemic stroke?

Population

1,051 adult patients with acute ischemic stroke, free of prior atrial fibrillation, who underwent in-hospital rhythm monitoring and CT angiography.

Exposure

Left atrial epicardial adipose tissue (LA-EAT) volume index assessment via CT

Outcome

Atrial fibrillation detected after stroke (AFDAS), defined as new-onset AF detected by ECG or rhythm monitoring during hospitalizationhard clinical

Larger left atrial epicardial adipose tissue volume is independently associated with new-onset atrial fibrillation after acute ischemic stroke and improves risk prediction beyond conventional factors.

Main Result

Odds Ratio: 1.07 (95% CI 1.04–1.09)

p-value: p=<0.001

Limitations

Single-center retrospective design with potential selection and information biases.
Temporal sequence and causal relationship between LA-EAT and AFDAS cannot be determined.
Small number of AFDAS events relative to the number of baseline variables evaluated, posing a risk of overfitting.
Rhythm monitoring relied on in-hospital continuous ECG and Holter recordings, likely underestimating the true incidence of AFDAS.
Focused only on early, in-hospital AFDAS without long-term follow-up for stroke recurrence or mortality.
Included only patients who underwent coronary or pulmonary CTA, introducing selection bias.
Data on stroke subtype, lesion location, and autonomic mechanisms were not available.

Abstract

Background Atrial fibrillation detected after stroke (AFDAS) is common yet mechanistically heterogeneous, reflecting both cardiogenic and neurogenic pathways. Inflammation plays an important role in this process. Left atrial epicardial adipose tissue (LA-EAT) is a marker of atrial remodeling and inflammation, but its relationship with AFDAS remains unclear. We investigated the association between LA-EAT and AFDAS and evaluated the incremental value of LA-EAT beyond conventional associated factors. Methods We conducted a single-center retrospective cohort study of 1051 consecutive patients with MRI‐confirmed acute ischemic stroke. All patients underwent contrast-enhanced CT angiography (pulmonary or coronary). AFDAS was defined as new-onset AF detected by ECG or rhythm monitoring during hospitalization in patients without prior AF. Results AFDAS occurred in 78/1051 patients (7.4%). LA-EAT volume index correlated moderately with LAVI (r = 0.481, p < 0.001). After adjusting for possible confounding factors, multivariate logistic regression analysis showed that the LA-EAT volume index was independently associated with AFDAS (OR = 1.07; 95% CI 1.04–1.09; p < 0.001). Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses demonstrated significant improvement when adding the LA-EAT volume index alone (NRI = 0.594; 95% CI 0.370–0.817; P = 0.001; IDI = 0.039; 95% CI 0.013–0.065; P = 0.004) or both LA-EAT metrics (NRI = 0.450; 95% CI 0.221–0.679; P = 0.001; IDI = 0.041; 95% CI 0.013–0.069; P = 0.004). Conclusions A larger LA-EAT volume is an independent associated factor for AFDAS in patients with acute ischemic stroke. Incorporating LA-EAT into clinical models significantly improves AFDAS risk assessment.

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