There is no data from South-East-Asian and Eastern Mediterranean regions about left heart factors contributing to the thromboembolic risk in ESUS.

Prospectively collected data on acute stroke was compared between non-cardioembolic (NCE), cardioembolic (CE) and ESUS stroke groups with respect to atrial and ventricle factors, their contribution to ESUS and stroke recurrence in relation to age.

Stroke sub-types were NCE 1348 (53.15%), CE 532 (21%) and ESUS 656 (25.8%). In multivariate analysis, ESUS had more diastolic dysfunction (DD) (aOR 2.15 95% CI 1.07-4.31, p=0.001), global hypokinesia (aOR 3.72, 95% CI 2.0-7.0, p=0.001), and cardiac wall motion abnormalities (CWMA) (aOR 7.14, 95% CI 4.44-10.90, p=0.001). ESUS had more CWMA (aOR 3.10, 95% CI 2.06-4.63, p=0.001) and higher LVMI (left ventricle mass index) (aOR 1.00, 95%CI 1.01-1.09, p=0.007) after adjusting for confounders. In ESUS age sub-groups, ≥61 years had more diabetes, hypertension, LAVI, CWMA, and higher CHA₂DS₂VASC.

Multivariate-cox-regression - Stroke recurrence in ESUS was 3 times higher (adjusted HR 3.16, 95% CI 1.80-5.54, p=0.001), ESUS age≥ 61 years (adjusted HR 2.88, 95% CI 1.17-7.06, p=0.02), global hypokinesia (aHR 3.25, 95% CI 1.54-3.97, p=0.002) and higher LAVI (left atrial volume index) (aHR 1.02, 95% CI 1.00-6.83, p=0.01) were also associated with a higher recurrence. Within ESUS sub-groups, age (aHR 1.03, 95% CI 1.00-1.05, p=0.02), higher LAVI score (aHR 1.03, 95% CI 1.01-1.05, p=0.002), diabetes (aHR 2.40, 95% CI 1.14-5.04, p=0.02) and hypertension (aHR2.93, 95% CI 1.04-8.27, p=0.04) were associated with recurrence. 95% recurrences happened on antiplatelets/anticoagulation

CWMA and DD were independently associated with ESUS. ESUS recurrence was more likely in older, diabetic, hypertensive and with higher LAVI. LAVI was independently associated with stroke recurrence. Anticoagulation/antiplatelets fail to prevent recurrence in most patients.