To evaluate the association between left atrial enlargement (LAE) and reduced ejection fraction (EF) with cardioembolic stroke 

Current guidelines for secondary stroke prevention in patients with atrial fibrillation (Afib) include anticoagulation; however, studies have failed to prove the benefit of anticoagulantion over antiplatelets in patients with heart failure without evidence of Afib. Studies have shown that heart failure and LAE are independent risk factors for stroke.  This would raise the question whether patients with reduced EF and LAE would benefit from anticoagulation. 

Two hundred eighteen patients had cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and LAE, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The odds of cardioembolic stroke were 8.8 times higher in patients with severely reduced EF compared to normal EF and 2.4 times higher in patients with LAE compared to normal left atrial size. The number of patients with reduced EF and LAE were higher in patients with cardioembolic stroke (P<0.001).

Our results showed an independent association between LAE and severely reduced EF with cardioembolic stroke warranting further studies to determine the appropriate treatment for secondary stroke prevention.