ESOC 2025 | Left atrial enlargement in patients with atrial fibrillation and breakthrough stroke

This study is based on the NOACISP registry, which is a prospectively collected cohort based at the University Hospital of Basel, including patients with atrial fibrillation and stroke. And we looked at them now retrospectively and at their echocardiographic data on left atrial enlargement and we tried to find out if there is a link between being under anticoagulant therapy at the time of the stroke at the time of the inclusion into the registry and the volume of the left atrium in TTE. And for the analysis we included 536 patients, all of them had a TTE, and we assessed left atrial diameter and left atrial volume index, and we found that in patients with breakthrough strokes. So those who were under anticoagulant therapy at the time of their stroke, they exhibit a much larger left atrium than those who were not on anticoagulant therapy. That was our primary hypothesis and our primary endpoint, and for the secondary endpoint we took follow-up data. So all these patients have been followed up for between one and a half to two years on average, and there we couldn’t find an association between left atrial enlargement and the risk for recurrent stroke. Actually, only the fact of being anticoagulated at the time of the index event was an independent risk factor and predictor for recurrence. This is a little bit opposed to existing data on left atrial enlargement, but these data mostly derived from lower-risk cohorts. So we’re not sure if in a high-risk cohort, as in ours, left atrial enlargement is just not a good marker to predict recurrence. And we hope to find more data in our prospective projects.

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