Abstract WP276: Predictors of Cardio-embolic Stroke in Therapeutically Anticoagulated Patients With Atrial Fibrillation

Abstract

Background: Anticoagulation reduces the risk of stroke in patients with Atrial Fibrillation(AF) . Ischemic stroke occurs in setting of AF despite adequate treatment because of both cardiac and non-cardiac causes. We hypothesized that certain cardiac abnormalities would increase the likelihood of cardio -embolic stroke(CES) in therapeutically anticoagulated patients with AF. Methods: We reviewed the records of all adults who were adequately anticoagulated with warfarin and admitted to our hospital with a diagnosis of ischemic stroke or transient ischemic attack between 01/01/2011 -06/30/2016. Stroke mechanism (CES vs non CES) using ASCOD criteria was determined by a vascular neurologist masked to the echocardiographic results. Cardiac studies were assessed independently by a cardiologist masked to the stroke mechanism. Categorical variables were analyzed with Chi square or Fisher exact test as appropriate. Continuous variables were analyzed using t test. P value <.05 was considered significant. Stepwise logistic regression was used to identify variable independently associated with CES. Results: 61 patients (39 patients with CES and 22 with non- CES ) were identified. In univariable analyses, CHF (59% vs 22.7%, p=0.006) was more common and Left atrial(LA) dimension (45 vs 39 mm, p=0.0139), LA volume (84 vs 66 mL, p=0.0133), Left ventricular(LV) mass (223 vs 166 gm, p=0.0008) and LV mass index (113.1 vs 92.88 gm/m2, p=0.016) larger with CES vs non- CES. Total cholesterol was higher in non- CES (175.9 vs 132.58 mg/dL, p=.0002). Stepwise logistic regression showed Left ventricular mass, Left ventricular mass index and total cholesterol were independently associated with CES (p=0.005, 0.018, 0.02. respectively). Conclusion: Patients with CES despite therapeutic anticoagulation had higher LV mass, LV mass index and lower total cholesterol compared to those with non- CES. Larger prospective studies are required to confirm these findings.