Abstract WMP64: Utility of Left Atrial Abnormality on Admission Electrocardiography in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yukio Sugiyama ◽  
Nobuyuki Ohara ◽  
Kotaro Watanabe ◽  
Junya Kobayashi ◽  
Daisuke Takahashi
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Strong Predictor ◽  
Multiple Logistic Regression Analysis ◽  
Cryptogenic Stroke ◽  
P Wave ◽  
Cardioembolic Stroke ◽  
Ecg Monitoring

Introduction and Hypothesis: Clinical categorization of ischemic stroke is very important to select the antithrombotic therapy for preventing the recurrent stokes. However, about 25% of ischemic stroke is the stroke for undetermined cause, termed as cryptogenic stroke. Recently, proactive detecting of paroxysmal atrial fibrillation (PAF) in cryptogenic stroke has gained attention. P-wave terminal force in lead V1 (PTFV1) of electrocardiography (ECG) is a specific indicator of left atrial abnormality. In this study, we tested PTFV1 for the utility of PAF detection and further clinical categorization in acute ischemic stroke. Methods: One hundred forty eight consecutive acute ischemic stroke patients were admitted to our hospital from September 2014 to March 2016. We included 105 patients (mean age 72.8±13.4 years), who had sinus rhythm on admission 12-lead ECG without atrial fibrillation, or cardiac pacing. PTFV1 (mmхsec) of participants was assessed, and had analyzed the association with PAF detection in a 24-hour ECG monitoring and clinical categories of ischemic stroke. Results: PTFV1 was significantly higher in the patients with PAF (n=11) than in those without PAF (0.049±0.024 vs 0.031±0.027; p<0.05). Multiple logistic regression analysis revealed that PTFV1 was an independent predictor for PAF detection (odds ratio, 1.46; 95% confidence interval, 1.02-2.08; p<0.05). According to the clinical categorization, PTFV1 of cardioembolic stroke (0.061±0.022) was significantly higher, compared to lacunar stroke (0.018±0.019; p<0.01), atherothrombotic stroke (0.035±0.026; p<0.05), and cryptogenic stroke (0.031±0.029; p<0.05). The proportion of patients with left atrial abnormality defined by PTFV1 (≧0.04), was 10 out of 11 (91%) for cardioembolic stroke, and 10 out of 27 (37%) for cryptogenic stroke. Conclusions: PTFV1 on admission ECG in acute ischemic stroke was a strong predictor for PAF detection and cardioembolic stroke diagnosis. Extended ECG monitoring may be useful in cryptogenic stroke with left atrial abnormality defined by PTFV1.

Abstract P709: Risk Factors Associated With Atrial Fibrillation Detection by Mobile Cardiac Outpatient Telemetry Following Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ovais Inamullah ◽  
Alec McConnell ◽  
Hussein Al-khalidi ◽  
Gerald S Bloomfield ◽  
Shreyansh Shah
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Stepwise Logistic Regression ◽  
Internal Diameter ◽  
Atrial Area

Background: Mobile Cardiac outpatient telemetry (MCOT) is often used for patients (pts) with cryptogenic ischemic stroke following hospital discharge to detect atrial fibrillation (AFib) but criteria for patient selection remains a subject of debate. Methods: We identified 297 pts hospitalized with acute ischemic stroke who had an inpatient transthoracic echocardiogram (TTE) and underwent MCOT upon discharge between 2016 and 2018 at a large academic comprehensive stroke center. Pts characteristics between AFib vs. no AFib were compared by Fisher’s exact test for categorical and Wilcoxon rank-sum test for continuous variables. A multivariable stepwise logistic regression model was developed to determine the predictors of AFib detection. Statistical hypotheses were tested as two-sided at 0.05 level of significance. Results: Of the 297 pts, AFib was detected in 24 (8.1%) on 30-day MCOT. Pts with AFib detected were older, white, and have had a larger left atrial area (Table). The final logistic model demonstrated that white race (vs. non-white) (OR 4.86, 1.53-15.41), left atrial area (OR 1.15, 1.05-1.25) and left ventricular internal diameter in diastole (OR 0.33, 0.16-0.67) were associated with AFib detection by MCOT. Conclusion: Although rates of AFib detection on 30-day MCOT post-discharge was low, there are important patient characteristics and TTE features that can improve patient selection. Further studies are needed to determine if this data can be used prospectively to clinically decide which pts with cryptogenic stroke should be given 30-day MCT to detect atrial fibrillation.

Abstract W MP65: Moderate to Severe Left Atrial Enlargement is Associated with Cardioembolic or Cryptogenic Stroke Recurrence in a Multiethnic Cohort: The Northern Manhattan Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Yeseon P Moon ◽  
Consuelo Mora-McLaughlin ◽  
Joshua Z Willey ◽  
Marco R Di Tullio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Subtypes ◽  
Multiethnic Cohort

Background: While left atrial (LA) enlargement increases incident stroke risk, the association with recurrent stroke is unclear. Our aim was to determine the association of LA enlargement (LAE) with stroke recurrence risk and recurrent stroke subtypes likely related to embolism (cryptogenic or cardioembolic). Methods: We enrolled 655 first ischemic stroke patients in the Northern Manhattan Stroke Study. LA size was measured by two-dimensional echocardiogram as part of the clinical evaluation and patients were followed annually for up to 5 years. LA size adjusted for sex and body surface area was categorized into three groups: normal (52.7%), mild LAE (31.6%), and moderate to severe LAE (15.7%). The outcomes were total recurrent stroke, and recurrent combined cryptogenic or cardioembolic stroke. Cox proportional hazard models assessed the association between LA size and risk of stroke recurrence. Results: Of 655 patients, LA size data was present in 529 (81%). Mean age was 69 ± 13 years; 46% were male and 18% had atrial fibrillation. Over a median of 4 years, recurrent stroke occurred in 83 patients (16%), 29 were cardioembolic or cryptogenic stroke. After adjusting for baseline demographics and risk factors including atrial fibrillation and congestive heart failure, compared to normal LA size, moderate to severe LAE was associated with greater risk of recurrent combined cardioembolic or cryptogenic stroke (adjusted HR 2. 99, 95% CI 1. 10 to 8.13), but not with risk of total stroke recurrence (adjusted HR 1.18, 95% CI 0.60 to 2.32). Mild LAE was not associated with either total stroke recurrence or the combined recurrent cryptogenic or cardioembolic stroke subtypes. Conclusion: Moderate to severe LAE is an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Future research is needed to determine if anticoagulant use reduces the risk of recurrence in ischemic stroke patients with moderate to severe LAE.

Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation

2018 ◽  
Vol 35 (4) ◽  
pp. 603-613 ◽  
Author(s):  
Andrea Sonaglioni ◽  
Antonio Vincenti ◽  
Massimo Baravelli ◽  
Elisabetta Rigamonti ◽  
Elena Tagliabue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Prognostic Value ◽  
Peak Strain

Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sebasigari ◽  
Alexander Merkler ◽  
Guo Yang ◽  
Benjamin Kummer ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Population Based ◽  
Embolic Stroke ◽  
P Wave ◽  
Left Atrial Diameter ◽  
New Diagnosis ◽  
Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lacalzada Almeida ◽  
V Armarnani Armarnani ◽  
J Garcia-Niebla ◽  
M M Izquierdo-Gomez ◽  
R Elosua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cox Regression ◽  
Imaging Techniques ◽  
P Wave ◽  
Control Group ◽  
End Point ◽  
Interatrial Block ◽  
New Onset

Abstract Background The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it. Purpose We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients. Methods Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both. Results During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002. Conclusions In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke. Acknowledgement/Funding None

scholarly journals Impact of excessive supraventricular ectopic activity detected in the acute phase of stroke or TIA on AF detection and death within 24 months – results of the prospective MonDAFIS study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K G H Haeusler ◽  
M C O Olma ◽  
S T Tuetuencue ◽  
C F Fiessler ◽  
C K Kunze ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Major Bleeding ◽  
Recurrent Stroke ◽  
First Episode ◽  
Ecg Monitoring ◽  
Ectopic Activity ◽  
Stroke Patients

Abstract Background/Introduction Detection of atrial fibrillation (AF) and subsequent initiation of oral anticoagulation remain key goals in the care of stroke patients. The European Society of Cardiology guideline recommend continuous ECG monitoring for at least 72 hours in stroke patients without previously known AF. Excessive supraventricular ectopic activity (ESVEA) has been identified as a marker for patients at risk for AF in the general population. Robust data on the clinical relevance of ESVEA detected in the acute phase of ischemic stroke or transient ischemic attack (TIA) are lacking. Purpose To assess the impact of ESVEA (defined as presence of supraventricular beats ≥480/day or at least one atrial run of ≥10 and &lt;30 seconds during continuous ECG monitoring for 72 hours) in patients with acute ischemic stroke/TIA without (previously) known AF on recurrent stroke, all-cause death and detection of a first episode of AF within 24 months. Methods The investigator-initiated, prospective, open, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke study randomized 3,465 acute stroke patients without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter-ECG recording for up to seven days in-hospital (NCT02869386). ECG core-lab analysis included the number of atrial ectopic beats per day, the number of atrial runs as well as the duration of the longest atrial run per 24 hours. Patients were followed-up for two years. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding and all-cause death in ESVEA patients, patients with newly diagnosed AF vs. non-ESVEA patients with sinus rhythm at baseline. Data were analyzed using Fisher's exact test. Results In 1,714 patients randomized to the intervention group, 1,693 (98.8%) had analyzable ECG recordings of a median duration of 121 hours (IQR 73–166). 1,435 (84.8%) patients had continuous ECG monitoring for the first 72 hours. At this time, ESVEA was detected in 363 (25.3%) of 1,435 patients, while a first episode of AF was detected in 48 (3.3%). At 24 months, AF was newly detected in 57 (15.7%) ESVEA patients vs. 53 (6.2%) non-ESVEA patients (p&lt;0.001) with available follow-up. At 24 months, 68 (24.5%) ESVEA patients vs. 77 (9.0%) non-ESVEA patients were on oral anticoagulation (p&lt;0.001). The composite of recurrent stroke, myocardial infarction, major bleeding and death at 24 months did not differ significantly between ESVEA patients vs. non-ESVEA patients (14.3% vs. 11.6%; p=0.389). However, all-cause death was higher in ESVEA patients (6.6% vs. 3.1% in non-ESVEA patients; p=0.01). Conclusions ESVEA detected after acute ischemic stroke/TIA identifies patients at high-risk for AF and may be used to guide prolonged ECG monitoring. The higher risk of death in ESVEA patients vs. non-ESVEA patients within 24 months after stroke/TIA deserves further investigation. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer Vital GmbH, Bayer HealthCare Pharmaceuticals, Germany.

Abstract WP268: Von Willebrand Factor Expression in Various Subtypes of Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Oana M Mereuta ◽  
Sean Fitzgerald ◽  
Mehdi Abbasi ◽  
Daying Dai ◽  
Ramanathan Kadirvel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Von Willebrand Factor ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Unknown Etiology ◽  
Learning Software ◽  
Von Willebrand ◽  
The Relationship ◽  
Willebrand Factor

Introduction: Von Willebrand factor (VWF) is a key component of acute ischemic stroke (AIS) thrombi. The aim of our prospective study was to investigate the immunohistochemical expression of VWF in clots and to evaluate whether VWF is associated with certain subtypes of AIS. Methods: VWF immunostaining was performed on 79 thrombi collected as part of the multi-center Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) registry. The cases were classified according to TOAST criteria. The VWF expression was quantified using Orbit Image Analysis (www.Orbit.bio) machine learning software. IBM SPSS statistics 25 was used to assess the relationship between the VWF levels and different etiology subtypes. Results: A cardioembolic stroke was defined in 39 cases (49.4%) whereas an atherosclerotic origin was identified in 13 patients (16.5%). Other causes accounted for 12 cases (15.1%). Unknown etiology was reported in 15 cases (19%). The mean VWF content in the clots was 12.8%. According to the Mann-Whitney U-test, the level of VWF was significantly higher in the cases with unknown etiology compared to cardioembolic origin (p=0.044). We found also that patients with unknown etiology of stroke had higher VWF expression as compared to the other two subtypes, although this difference was not statistically significant. Conclusions: Among the patients with ischemic stroke included in this study, the VWF expression was significantly increased in those with unknown etiology compared to the group with cardioembolic stroke. Our finding provides new insights into clot composition in cryptogenic stroke and may influence the treatment and secondary prevention in these cases.

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Abstract WP256: Atrial Fibrillation Predicting Factors in Transient and Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Marian Muchada Lopez ◽  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco-Pascual ◽  
Alejandro Bustamante ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Volume Index ◽  
Minor Stroke ◽  
Stroke Patients ◽  
Left Atrial Strain ◽  
Minor Ischemic Stroke ◽  
Atrial Strain

Introduction and Purpose: Our aim was to review the characteristics of transient ischemic attack (TIA) and minor ischemic stroke patients monitored for atrial fibrillation (AF) epidoses detection within the first 4weeks after stroke to assess AF predictors. Materials and Methods: TIA and minor ischemic stroke patients (nihss≤ 5) were selected from CRYPTO-AF database. CRYPTO-AF is a prospective multicentre registry of patients with cryptogenic stroke older of 55 year-old. Monitoring started within the first 72 hours from stroke symptoms onset and was prolonged for 4 weeks. Clinical, cardiographic and blood test parameters of patients included were reviewed. Fisher exact and Mann Whitney tests were used to analyze categorical and continuous data. Results: In our cohort of 152 transient and minor ischemic stroke patients, 55.9% were men, mean age 73.18±10.24 and median NIHSS score was 2.31(0-5). A total of 30 patients (20.3%) were diagnosed with AF in the first month of monitoring, 6 patients (5.7%) within the first 3 days, 14 patients (13.3%) between 3 days and to 2 weeks of monitoring, and 14 partientes (12.4%) between the second and the fourth week. In these transient and minor ischemic stroke patients, age (p< 0.031), left atrial volume index (p< 0.023), the appearance of isolated extrasystoles during monitoring (p< 0.021), Type B natriuretic peptide (p< 0.011) and the longitudinal strain (p< 0.019) appeared as independet precitors of AF. However in the multivariate analysis adjusted for the above variables, only left atrial strain (OR 0.89, 95% CI: 0.797-0.991, p< 0.034) independently predicts AF detection. Conclusions: In our serie, only the left atrial strain appeared as a indepent predictor of AF. Given the known pathophysiology of TIA and minor ischemic stroke, the description of AF predictors would help to identify those patients who would benefit from completing a longer monitoring. More studies are needed to identify these predictors.

Abstract TP173: Reduced Ejection Fraction and Left Atrial Dilatation are Independently Associated With Cardioembolic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maryam Hosseini Farahabadi ◽  
Shadi Milani-Nejad ◽  
Shimeng Liu ◽  
Wengui Yu ◽  
Mohammad Shafie
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Cardioembolic Stroke ◽  
Left Atrial Size ◽  
Reduced Ejection Fraction ◽  
Atrial Size ◽  
Left Atrial Dilatation

Introduction: The role of heart failure and left atrial dilatation as independent risk factors for ischemic stroke has remained controversial. The goal of this study is to evaluate the association between reduced ejection fraction (EF) and left atrial dilatation with cardioembolic stroke. Methods: 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 within 3 months of diagnosis. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. EF 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/m 2 ) vs. enlarged (≥35 ml/m 2 ), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of atrial fibrillation. Results: Two hundred eighteen patients were identified to have 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 enlarged left atrium, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The number of patients with reduced EF and left atrial enlargement were significantly higher in patients with cardioembolic stroke (P<0.001). The odds of cardioembolic stroke were 2.0 and 8.8 times higher in patients with moderately and severely reduced EF, respectively, when compared to patients with normal EF. The odds of cardioembolic stroke was 2.4 times higher in patients with enlarged left atrial size when compared to patients with normal left atrial size. Conclusions: Our results have shown an independent association between moderately and severely reduced EF and enlarged left atrial size with cardioembolic stroke. Heart failure and left atrial dilatation may increase the risk of stroke regardless of the presence of atrial fibrillation, which warrants further studies to determine the appropriate treatment for secondary stroke prevention such as anticoagulation.

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