The determinants of stroke phenotypes were different from the predictors (CHADS(2 )and CHA(2)DS(2)-VASc) of stroke in patients with atrial fibrillation: a comprehensive approach

BACKGROUND: Atrial fibrillation (AF) is a leading cause of fatal ischemic stroke. It was recently reported that international normalized ratio (INR) levels were associated with infarct volumes. However, factors other than INR levels that affect stroke phenotypes are largely unknown. Therefore, we evaluated the determinants of stroke phenotypes (pattern and volume) among patients with AF who were not adequately anticoagulated. METHODS: We analyzed data pertaining to consecutive AF patients admitted over a 6-year period with acute MCA territory infarcts. We divided the patients according to DWI (diffusion-weighted imaging) lesion volumes and patterns, and the relationship between stroke predictors (the CHADS(2 )and CHA(2)DS(2)-VASc score), systemic, and local factors and each stroke phenotype were then evaluated. RESULTS: The stroke phenotypes varied among 231 patients (admission INR median 1.06, interquartile range (IQR) 1.00-1.14). Specifically, (1) the DWI lesion volumes ranged from 0.04-338.62 ml (median 11.86 ml; IQR, 3.07-44.20 ml) and (2) 46 patients had a territorial infarct pattern, 118 had a lobar/deep pattern and 67 had a small scattered pattern. Multivariate testing revealed that the CHADS(2 )and CHA(2)DS(2)-VASc score were not related to either stroke phenotype. Additionally, the prior use of antiplatelet agents was not related to the stroke phenotypes. Congestive heart failure and diastolic dysfunction were not associated with stroke phenotypes. CONCLUSIONS: The results of this study indicated that the determinants of stroke phenotypes were different from the predictors (i.e., CHADS2 and CHA(2)DS(2)-VASc score) of stroke in patients with AF.