Is left atrial diameter related to ischemic stroke?

Purpose: Stroke is the second leading cause of death and the third leading cause of disability worldwide. The highest recurrence rates are observed in subtypes such as large artery atherosclerosis (LAA) and cardioembolic (CE) stroke. Atrial fibrillation (AF) is a common cause of CE. However, the role of increased left atrial (LA) size as a potential risk factor for ischemic stroke remains controversial. This study aimed to evaluate whether LA size is associated with the long-term risk of stroke recurrence in patients with non-valvular atrial fibrillation.Materials and methods: This retrospective study included 191 patients diagnosed with ischemic stroke by a specialist neurologist at Afyonkarahisar University of Health Sciences between January 1, 2024, and June 1, 2024. Patients aged >18 years with acute ischemic stroke were included. Patients with a history of ischemic stroke who had not undergone transthoracic echocardiography were excluded. The etiological subtype of ischemic stroke was determined according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria.Results: A total of 191 patients were included. Of these, 155 (81.2%) had non-recurrent stroke, while 36 (18.8%) experienced recurrent stroke. Smoking was significantly more common in patients with recurrent ischemic stroke (30.6% vs. 16.1%; p=0.046). The prevalence of AF was also higher in the recurrent stroke group (33.3% vs. 12.9%; p=0.003). Moreover, LA diameter was significantly greater in patients with recurrent ischemic stroke (median [interquartile range]: 43 [35.75-47] vs. 35 [33-37]; p<0.001).Conclusion: This study demonstrates that increased LA diameter, smoking, and AF are associated with a higher risk of recurrent ischemic stroke. Notably, larger LA diameter may contribute to blood stasis and thrombus formation in the left atrium, thereby elevating the risk of CE events. Further research is warranted to confirm these associations and strengthen the current evidence base.