Abstract 18093: History of Stroke as a Predictor of High Left Atrial Fibrosis in Patients With Persistent Atrial Fibrillation

Abstract

Introduction: The relationship between left atrial (LA) remodeling and ischemic stroke (IS) risk in patients with atrial fibrillation (AF) is well-established. The DECAAF II trial is the largest MRI-based, multicenter, randomized study conducted on persistent AF patients. Hypothesis: Our research investigates whether a history of stroke correlates with the extent of atrial fibrosis, as determined by late gadolinium enhancement magnetic resonance imaging (LGE-MRI), among the DECAAF II trial population. Methods: Patients with persistent AF who underwent LGE-MRI were enrolled and categorized into two cohorts: those with a history of stroke and those without. Covariates were adjusted using propensity score matching, and atrial fibrosis was compared between groups. Participants were then subdivided according to three baseline atrial fibrosis cut-off values: ≥ 15%, ≥ 20%, ≥ 25%. Univariate logistic regression and adjusted multivariate analyses were applied to evaluate the impact of clinical characteristics and risk factors on baseline fibrosis. Results: From the 843 patients involved in the DECAAF II trial, 70 (8.3%) had a stroke history. Those with stroke history had higher rates of hypertension, diabetes, and hyperlipidemia. Seventy patients without a stroke history were matched to stroke patients using propensity score analysis, revealing a significantly higher fibrosis in the stroke group (20.2% vs. 8.1%, p = 0.017). Increasing age significantly predicted all three baseline fibrosis categories (≥15%, ≥20%, ≥25%). Notably, stroke history was as a predictor of baseline fibrosis ≥25%, even after adjusting for other risk factors and clinical characteristics (OR = 1.98 [1.14-3.43], p = 0.01). Conclusions: There is a significant correlation between high left atrial fibrosis level and an increased risk of ischemic stroke in patients with persistent atrial fibrillation. This suggests that atrial fibrosis may provide insights into stroke risk classification.