Abstract
Background: While left atrial enlargement (LAE) is associated with increased risk for incident acute ischemic stroke (AIS), the association between LAE and outcomes following AIS is not well described. This study aimed to examine the relationship between LAE and short-term functional outcomes in the setting of AIS. Methods: This is a cross-sectional study of consecutively admitted AIS patients at a single high-volume stroke center. Patients over 18 years old diagnosed with AIS between 2008-2015 were included. After adjusting for key covariates, we analyzed whether patients with LAE (LAE+) experienced worse outcomes compared to patients without LAE (LAE-). The primary outcome of interest was poor functional outcome, defined as a modified Rankin Scale score (mRS) of 4-6 at discharge. The secondary outcome of interest was neuroworsening, defined as an increase in NIHSS score of 2 points of more within 24 hours. Results: Of 1,082 patients included, 50.6% were LAE+. Patients in the LAE+ group had a higher median age (67 vs. 62, p<0.001) and admission NIHSS (6 vs. 5, p<0.001). Patients the LAE+ group also differed significantly in frequency of history of hypertension (87.2% vs. 74.0%, p<0.001), history of diabetes (40.4% vs. 33.1%, p=0.015), history of atrial fibrillation (19.7% vs. 3.2%, p<0.001), and history of congestive heart failure (19.3% vs. 4.2%, p<0.001). After adjustment for age, baseline NIHSS, and tPA exposure, the odds of poor functional outcome was 1.83 times greater in the LAE+ group compared to the LAE- group (OR 1.83, 95% CI 1.33-2.52). Additionally, after adjustment for age, baseline NIHSS, and tPA exposure, the odds of neuroworsening was 1.48 times greater in the LAE+ group compared to the LAE- group (OR 1.48, 95% CI 1.10-1.99). Discussion: The results of this study suggest that LAE may herald neurological worsening and worse functional outcomes following AIS. Stroke-treating neurologists may regard detection of LAE as an opportunity to heighten monitoring and early intervention for neurological worsening.
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