Abstract
Abstract Background Atrial fibrillation detected after stroke (AFDAS) is common yet mechanistically heterogeneous, reflecting both cardiogenic and neurogenic pathways. Inflammation plays an important role in this process. Left atrial epicardial adipose tissue (LA-EAT) is a marker of atrial remodeling and inflammation, but its relationship with AFDAS remains unclear. We investigated the association between LA-EAT and AFDAS and evaluated the incremental value of LA-EAT beyond conventional associated factors. Methods We conducted a single-center retrospective cohort study of 1051 consecutive patients with MRI‐confirmed acute ischemic stroke. All patients underwent contrast-enhanced CT angiography (pulmonary or coronary). AFDAS was defined as new-onset AF detected by ECG or rhythm monitoring during hospitalization in patients without prior AF. Results AFDAS occurred in 78/1051 patients (7.4%). LA-EAT volume index correlated moderately with LAVI (r = 0.481, p < 0.001). After adjusting for possible confounding factors, multivariate logistic regression analysis showed that the LA-EAT volume index was independently associated with AFDAS (OR = 1.07; 95% CI 1.04–1.09; p < 0.001). Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses demonstrated significant improvement when adding the LA-EAT volume index alone (NRI = 0.594; 95% CI 0.370–0.817; P = 0.001; IDI = 0.039; 95% CI 0.013–0.065; P = 0.004) or both LA-EAT metrics (NRI = 0.450; 95% CI 0.221–0.679; P = 0.001; IDI = 0.041; 95% CI 0.013–0.069; P = 0.004). Conclusions A larger LA-EAT volume is an independent associated factor for AFDAS in patients with acute ischemic stroke. Incorporating LA-EAT into clinical models significantly improves AFDAS risk assessment.