ABSTRACT Background: Stroke is the second leading cause of death worldwide. Recently, atrial cardiopathy has become recognized as a substantial risk factor for cerebrovascular stroke. Greater LA size is linked to stroke in AF patients, but few data linking LA size to stroke in population with sinus rhythm. Aim: To investigate the value of total atrial conduction time (TACT) measured non-invasively by assessing PA-TDI duration as a predictor of stroke in patients who initially presented with sinus rhythm and have normal LV systolic function. Patients and methods: In our case-control study, we studied patients were admitted to Zagazig university hospital with acute ischemic stroke. It included 156 patients with acute ischemic stroke and 50 control subjects all presented in sinus rhythm and normal LV systolic function. All participants underwent echocardiography. The bi-plane modified Simpson's approach was used to determine the left ventricular ejection fraction. The left atrial (LA) diameter was measured also left atrial volume index (LAVI) was assessed and indexed for body surface area using. The PA-TDI interval was used to estimate the TACT. The average of the measurements made at the septal and lateral annuli was taken into account. Results: There was no statistically significant difference between both groups regarding LA diameter (p: 0.3), LA volume index was larger in the stroke group (39.24±4 versus 33.6±2.8, p: 0.01), PA-TDI duration showed statistical highly significant difference between both groups (165.94±21.695 versus 99.4±22.960, p: <0.001). ROC curve showed the best cutoff point for LA volume index is >42.2 ml/m2 for prediction of stroke with area under the curve: 0.7, 52.8 % sensitivity, 80.8% specificity, p value is 0.005. ROC curve showed the best cutoff point for PA-TDI is >155.5 ms for prediction of stroke with area under the curve: 0.9, 70 % sensitivity, 78% specificity, p value: <0.001. Using multivariate logistic regression analysis showed that hypertension, LA volume index and PA-TDI duration are independent predictors of stroke (p: < 0.05, < 0.05, and < 0.001 respectively). Conclusion: The assessment of electromechanical asynchrony by measuring the PA-TDI duration on echocardiography in population with sinus rhythm and normal systolic function may help to predict patients at risk for stroke. We also advise patients who exceed the cutoff points of LA volume index and PA-TDI duration to receive antithrombotic therapy for better stroke prevention. Keywords: Atrial asynchrony