Free fatty acid as a determinant of ischemic lesion volume in nonarterial-origin embolic stroke.

GOALS: This study aimed to determine whether the plasma levels of free fatty acid (FFA) are associated with ischemic lesion characteristics in nonarterial-origin embolic stroke. MATERIALS AND METHODS: We prospectively recruited 254 patients with acute cerebral infarction caused by cardioembolic stroke (CES, n=121) or with embolic stroke of undetermined source (ESUS, n=133). Plasma levels of FFA were measured during the acute stage (median of 2days after stroke onset). Acute ischemic lesions on diffusion-weighted imaging were measured in terms of size, composition, and pattern. Transthoracic echocardiography parameters were evaluated in all patients. FINDINGS: Plasma levels of FAA were not different in CES and ESUS patients (mEq/L, 0.78±0.52 vs. 0.67±0.61, P=0.120). Echocardiography parameters, including left atrium volume index and E/e', were higher, and the ischemic lesion volume was larger in patients with CES than in those with ESUS. The ischemic lesion volume and the proportion of patients with mixed (small and large) and large cortical lesions increased with FFA quartile in both CES and ESUS groups. In a multivariable analysis, FFA level (coefficient, 5.249; standard error, 3.447; P=0.001), atrial fibrillation (coefficient, 7.673; standard error, 1.855; P<0.001), and fasting glucose (coefficient, 0.104; standard error, 0.023; P<0.001) were associated with ischemic lesion volume in nonarterial-origin embolic stroke. CONCLUSION: Elevated plasma FFA levels are associated with larger ischemic lesion volumes and a higher prevalence of large cortical infarcts in patients with nonarterial-origin embolic stroke regardless of the presence of a high-risk cardioembolic source.