Does Fasting Triglyceride Level Influence Core Infarct Volume in Acute Stroke?

Objective: Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients. Methods: We performed a retrospective chart review and cross-sectional analysis of AIS patients admitted to a tertiary care center in Kansas from 2010 to 2023. Inclusion criteria were AIS patients who (1) underwent CTA and CTP within 24 hours of stroke onset, and (2) had fasting triglyceride levels measured within 24 hours of admission. Infarct volume was calculated using RAPID software (iSchemaView Inc.). Statistical analyses were conducted using STATA (Release 16), with T tests, ANOVA, χ 2 tests, and multivariable linear regression applied as appropriate. Results: We included 178 patients, 52% (n=92) of whom were male, and 31% were aged 61 to 70 years. Mean TG levels were 116.91±70.23 mg/dL, and mean infarct volume was 41.64±53.35 mL. Linear regression showed a significant positive association between TG levels and infarct volume ( P <0.01, β=0.17, 95% CI: 0.06-0.28), with a 0.17 mL increase in infarct volume per unit increase in TG levels. Patients with Embolic stroke of undetermined source (ESUS) had larger infarct volumes compared with those with large artery atherosclerosis ( P <0.05) and the highest mean TG levels (135.61 mg/dL). Conclusion: Hypertriglyceridemia was positively associated with larger infarct volumes, particularly in ESUS patients, who had the highest TG levels and larger infarct sizes. These findings suggest that elevated TG may predict worse stroke outcomes and could be a potential therapeutic target for stroke prevention.