Relationship between D-dimer levels and infarct pattern in acute ischemic stroke patients with non-valvular atrial fibrillation

Background: Cerebral embolism in patients with non-valvular atrial fibrillation (NVAF) is mainly caused by thrombus formation in the left atrial appendage. D-dimer is known to reflect the thrombogenic activity of the left atrium in NVAF patients. This study aimed to investigate the relationship between D-dimer levels and infarct pattern in ischemic stroke patients with NVAF. Methods: We enrolled 255 patients who developed cardioembolic stroke caused by NVAF and presented to the hospital within 7 days. We divided the infarct pattern into two groups: single lesions (SL) and multiple lesions (ML). The infarct pattern was also classified into two groups: ischemic lesions involving a single vascular territory (ST) and multiple vascular territories (MT). We analyzed the relationship between the infarct pattern and D-dimer levels. Results: Of the 255 patients, 79 (31.0%) and 176 (69.0%) were in the SL and ML groups, respectively. In addition, 207 (81.2%) and 48 (18.8%) patients were classified into the ST and MT groups, respectively. Compared with the SL group, a higher D-dimer level was observed in the ML group (p=0.006). Similarly, the MT group had higher D-dimer levels than the ST group (p=0.001). Logistic regression analysis showed that elevated D-dimer levels were significantly and independently associated with the presence of multiple ischemic lesions (p=0.021) and the involvement of multiple vascular territories (p=0.020). Conclusions: This study showed that elevated D-dimer levels were independently associated with multiple ischemic lesions involving multiple vascular territories in ischemic stroke patients with NVAF.