Abstract
Background and aims: We investigated the association between left atrial appendage (LAA) filling patterns on cardiac CT and long-term outcomes after ischemic stroke.
Methods: In this pre-specified subanalysis of the AIS of HEARTS study, acute ischemic stroke (AIS) patients (May 2018-March 2023) undergoing cardiac CT during the acute stroke imaging protocol were categorized as having LAA thrombus (low-attenuated, well-defined filling defect), slow-flow (filling defect not meeting throm-bus criteria), or normal filling. We evaluated two-year functional outcome (modified Rankin Scale), recurrent ischemic stroke, and major adverse cardiovascular events (MACE) using ordinal and Cox regression, with sensitivity analysis in cryptogenic stroke.
Results: Among 2825 patients (57% male; median age 73 [IQR 63– 82] years), 149 (5%) had LAA thrombus, 456 (16%) slow-flow, and 2220 (79%) normal filling. Thrombus and slow-flow patients had a higher prevalence of known AF (66%, 52%, and 15%; P < 0.001) and baseline NIHSS (median 12, 8 and 5, P < 0.001). In adjusted analyses, thrombus was associated with worse functional outcome (acOR 1.79 95%CI [1.23–2.61]), whereas slow-flow was not (acOR 1.02 [0.82–1.2]). Neither thrombus or slow-flow were associated with MACE (aHR 1.26 [0.93-1.72] and aHR 1.14 [0.92–1.41]) or overall recurrent ischemic stroke (aHR 1.08 [0.59-1.98] and aHR 1.06 [0.76–1.49]), but slow-flow was associated with recurrence in cryptogenic stroke patients (n = 443, aHR 2.39 [1.03–5.54]).
Conclusions: LAA thrombus was associated with worse two-year functional outcome, whereas slow-flow was not. Slow-flow and thrombus were not associated with MACE or overall stroke recurrence , but slow-flow was associated with recurrent stroke in cryptogenic stroke.