Objective To observe the relationship between left ventricular wall motion abnormality (LVWMA) and stroke recurrence in patients with ischemic stroke. Methods A prospective cohort study was performed in 864 patients with acute ischemic stroke. The relevant examinations were completed and the patients were divided into LVWMA-positive group (278 cases) and LVWMA-negative group (586 cases). Follow-up was performed after discharge to record the recurrence of stroke. Results There were statistically significant differences in gender, age, hypertension, diabetes, coronary heart disease, arrhythmia, valvular heart disease, incidence of left ventricular ejection fraction <30%, C-reactive protein, triglyceride, total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), N-terminal pro-brain natriuretic peptide (NT-proBNP), taking antiplatelet drugs or anticoagulants, and Org10172 therapeutic trial for acute stroke genotyping between the two groups (P < 0.05). The incidences of stroke in the 12th and 24th months of follow-up were significantly different between the two groups (P < 0.05). Single factor logistic regression analysis showed that the risk of ischemic stroke recurrence in the LVWMA-positive group was 2.61 times that of the LVWMA-negative group; and age, smoking,hypertension, diabetes, coronary heart disease, TC, LDL-C, fasting blood glucose, NT-proBNP, taking anticoagulants at discharge, cardiogenic cerebral embolism stroke and aortic atherosclerotic stroke were the risk factors for stroke recurrence in ischemic stroke (P < 0.05). After adjusting various factors, the risk of stroke recurrence in the LVWMA-positive group was 2.97 times that in the LVWMA-negative group. Conclusions LVWMA may cause left ventricular thrombosis and is an independent risk factor for recurrent ischemic stroke.