Stroke severity in concomitant cardiac sources of embolism in patients with atrial fibrillation

Background: Atrial fibrillation (AF), which is the most common etiology of cardioembolic stroke, may be accompanied by other cardiac sources of embolism. The heterogeneity and multiplicity of the cardiac sources of embolism may influence stroke severity via formation of thrombi with heterogenous compositions, ages, and sizes. We investigated among stroke patients with AF whether stroke severity is different between patients with concomitant potential cardiac sources of embolism and those without. Methods: The subjects for this study were consecutive patients with cerebral infarction and AF who underwent transesophageal echocardiography during a 10-year period. The definitions and determination of high- and medium-risk potential cardiac sources of embolism were based on the Trial of Org 10172 in Acute Stroke Treatment classification. Initial stroke severity and infarct sizes were compared between patients with concomitant potential cardiac sources of embolism and those without. Results: Of the 266 patients enrolled, 181 (68.0%) had one or more concomitant potential cardiac sources of embolism. Left atrial thrombus and spontaneous echo contrast were most common. Patients with concomitant potential cardiac sources of embolism had a higher median score on the initial National Institute of Health Stroke Scale (6 vs. 3, p = 0.005) and a larger infarction diameter (45.4 ± 31.3 mm vs. 35.5 ± 26.6 mm, p = 0.002) than those without. Occlusion of the symptomatic arteries was more frequently detected in patients with concomitant potential cardiac sources of embolism. Conclusions: Stroke patients with AF frequently had concomitant potential cardiac sources of embolism, and strokes were more severe in them.