Left atrium dilatation and multiple vascular territory strokes.
BACKGROUND
Atrial fibrillation (AF) is a cause of ischemic stroke and is associated with recurrence and with acute multi-vessel territory non lacunar stroke. Many cryptogenic strokes could be secondary to undiagnosed paroxystic AF. As left atrium (LA) dilatation is a risk factor of AF, we sought to determine if moderate or severe LA dilatation was associated with multiple vascular territory infarcts on magnetic resonance imaging (MRI) in patients with acute ischemic stroke without known AF. Normal LA diameter values are ≤4.0 cm for men and ≤3.8 for women.


METHODS
Patients who presented at our center between 2006 and 2011 with a diagnosis of acute ischemic stroke (AIS) or transient ischemick attack (TIA) who had a transthoracic echocardiography and a brain MRI were included. Patients with known or de novo AF diagnosed within 3 months of the event were excluded. The main outcome was the presence of acute multi-vessel territory infarct(s) on MRI.


RESULTS
356 patients were included. The mean LA diameter was 37 mm in the control group (normal or mildly dilated LA) and 49 mm in those with moderately to severely enlarged LA (p<0.001). More patients in the LA dilatation group met the main outcome (20% vs 6%; OR 3.89; 95% CI 1.32-11.43; p=0.0014).


CONCLUSIONS
LA dilatation (at least moderate) is associated with acute non lacunar multiple vascular territory infarcts on MRI in patients with AIS or TIA without known AF or a confirmed diagnosis of AF. Further studies are necessary to determine if this population might benefit from anticoagulation therapy.
1Department of Neurology, Faculty of Medicine,Sherbrooke University,Sherbrooke,Greenfield Park,Quebec,Canada.
Marie-Sarah
MS
Gagne Brosseau
1Department of Neurology, Faculty of Medicine,Sherbrooke University,Sherbrooke,Greenfield Park,Quebec,Canada.
Jean-Martin
JM
Boulanger
2Charles-LeMoyne Hospital - Neurology,Greenfield Park,Quebec,Canada.
Nancy
N
Leblanc
2Charles-LeMoyne Hospital - Neurology,Greenfield Park,Quebec,Canada.
Leo
L
Berger
3Charles-LeMoyne Hospital - Cardiology,Greenfield Park,Quebec,Canada.
Micheal
M
Benzazon
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*