Key result
Left atrial enlargement is linked to ~3.8-fold higher odds of prolonged CT perfusion AIF dispersal.
Why the study?
Arterial input function (AIF) dispersal on brain CT perfusion reflects delayed cerebral contrast transit and is associated with reduced LVEF, and it was hypothesized that delayed contrast transit due to left atrial enlargement might prolong AIF independent of LVEF.
Cohort (n=172)
Both left atrial enlargement and reduced LVEF are independently associated with prolonged arterial input function dispersal on brain CT perfusion, suggesting AIF delay is a useful screening tool for underlying cardiac dysfunction in acute stroke patients.
Answers are grounded in this paper and cite their sources.
Prolonged AIF dispersal was independently associated with LA enlargement and reduced LVEF; supports further evaluation of CTP AIF as a cardiac screening marker in stroke.
INTRODUCTION: Arterial input function (AIF) dispersal on brain computed tomography (CT) perfusion reflects delayed cerebral contrast transit and is associated with reduced left ventricular ejection fraction (LVEF). We hypothesized that delayed contrast transit through the LA due to LA enlargement may prolong AIF, independent of LVEF. PATIENTS AND METHODS: We analyzed patients with ischemic stroke or transient ischemic attack from the prospective INSPIRE registry (December 2020-June 2024) who underwent multimodal CT including brain perfusion CT (CTP), as well as transthoracic echocardiography (TTE) within 90 days of stroke. On TTE, left atrial (LA) enlargement was defined as area ≥ 24 cm² and left ventricular ejection fraction (LVEF) as < 50%. Prolonged AIF dispersal from CTP was defined as ≥ 29 s from scan onset to the end of AIF (return to baseline). Multivariable logistic regression was performed, adjusted for clinical and cardiac covariates. RESULTS: Among 172 patients, prolonged AIF was observed in 50 (29.1%), LA enlargement in 52 (30.2%), and reduced LVEF in 28 (16.3%). In multivariate analysis including both variables, LA enlargement (≥24 cm²: OR 3.76, 95% CI 1.66-8.52, p = 0.002) and reduced LVEF (OR 3.35, 95% CI 1.21-9.27, p = 0.020) were independently associated with prolonged AIF dispersal. DISCUSSION AND CONCLUSION: Both LA enlargement and reduced LVEF were associated with prolonged AIF dispersal, suggesting that AIF delay on CTP is a useful screening tool to identify stroke patients with cardiac dysfunction.
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Shiga et al. (2026) conducted a cohort in Ischemic stroke or transient ischemic attack (n=172). Left atrial enlargement (LA area >= 24 cm^2) and reduced LVEF (< 50%) on transthoracic echocardiography vs. Normal left atrial size (< 24 cm^2) and preserved LVEF (>= 50%) was evaluated on Prolonged arterial input function (AIF) dispersal on brain CT perfusion (>= 29 s from scan onset to the end of AIF) (OR 3.76, 95% CI 1.66-8.52, p=0.002). Left atrial enlargement (>=24 cm2) was independently associated with prolonged CT perfusion arterial input function dispersal (OR 3.76; 95% CI 1.66-8.52; p=0.002).
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