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Non-cardioembolic risk factors in atrial fibrillation-associated ischemic stroke.

 Pil-Sung Yang  ;  Hui-Nam Pak  ;  Dong-Hyuk Park  ;  Joonsang Yoo  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Young Dae Kim  ;  Hyo Suk Nam  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Ji Hoe Heo 
 PLOS ONE, Vol.13(7) : e0201062, 2018 
Journal Title
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INTRODUCTION: Cardioembolic (CE) risks is usually considered as the main mechanism of ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, a substantial number of ischemic strokes in NVAF patients are related to non-CE mechanisms. The aim of this study was to investigate the non-CE risk factors in ischemic stroke patients had NVAF.

METHODS: We included 401 patients (65.6% male, 68.6 ± 9.6 years old) who had been hospitalized due to ischemic stroke and had a known or newly diagnosed NVAF. The CE (intracardiac thrombus, dense spontaneous echo contrast, or low left atrial appendage flow velocity) and non-CE (complex aortic plaque, significant carotid stenosis, or intracranial arterial stenosis) risk factors were investigated at the time of the index stroke.

RESULTS: The number of CE and non-CE risk factors increased with increasing CHA2DS2-VASc scores (p for trends < 0.001). The presence of CE risk factors was independently associated with persistent atrial fibrillation (p < 0.001), body mass index (p = 0.003), heart failure (p = 0.003), and left atrial volume index (p < 0.001). In contrast, the presence of non-CE risk factors was independently associated with age (p < 0.001), hypertension (p = 0.049), diabetes (p = 0.030), and coronary artery calcium score (CACS; p < 0.001). CACS had the added value in predicting non-CE risk factors of ischemic stroke regardless of the CHA2DS2-VASc risk category (p < 0.001).

CONCLUSION: Non-CE risk factors in ischemic stroke patients with NVAF are associated with high CHA2DS2-VASc score and CACS. Atherosclerotic non-CE risk factors should be considered as potential mechanisms of stroke even in patients with AF-associated ischemic stroke.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Park, Dong Hyuk(박동혁)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Yang, Pil Sung(양필성)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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