Why the study?
Atrial cardiomyopathy severity may explain why some AF patients develop large vessel occlusion while others experience distal cardioembolic strokes, prompting evaluation of cardiac CT markers in this population.
Are atrial cardiomyopathy markers detected on acute combined brain-cardiac CT (such as left atrial volume, epicardial adipose tissue, and left atrial appendage thrombus) associated with large vessel occlusion in patients with atrial fibrillation presenting with acute ischemic stroke?
Are atrial cardiomyopathy markers detected on acute combined brain-cardiac CT (such as left atrial volume, epicardial adipose tissue, and left atrial appendage thrombus) associated with large vessel occlusion in patients with atrial fibrillation presenting with acute ischemic stroke?
In patients with atrial fibrillation presenting with acute ischemic stroke, left atrial volume > 90 mL on emergency cardiac CT and female sex are independently associated with large vessel occlusion, highlighting the role of atrial cardiomyopathy in severe cardioembolic stroke.
Answers are grounded in this paper and cite their sources.
May support AtCM evaluation on acute CT in AF stroke; leaves open whether it refines LVO risk stratification.
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.
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M’Rabet et al. (2025) studied this question.
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