Left Atrial Appendage Morphology and Embolic Stroke of Undetermined Source: A Cross-Sectional Multicenter Pilot Study

Yaghi, Shadi; Chang, Andrew; Hung, Peter Shih-Ping; Grory, Brian Mac; Collins, Scott; Gupta, Ajay; Reynolds, Jacques; Finn, Caitlin; Hemendinger, Morgan; Cutting, Shawna; McTaggart, Ryan; Jayaraman, Mahesh; Leasure, Audrey C; Sansing, Lauren H; Panda, Nikhil; Song, Christopher; Chu, Antony; Merkler, Alexander E; Gialdini, Gino; Sheth, Kevin N; Kamel, Hooman; Elkind, Mitchell S.V.; Greer, David M.; Furie, Karen L.; Atalay, Michael K.

doi:10.1016/j.jstrokecerebrovasdis.2017.12.036

Cited by 24 publications

(15 citation statements)

References 13 publications

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“…Kimura et al reported that poor enhancement was not a factor relevant to stroke (15); however, in their study, this point was not a keynote, and their definition of poor enhancement is unclear. Yaghi et al reported that the prevalence of non-chicken wing LAA morphology was higher among patients with cardiogenic stroke and embolic stroke of undetermined source than among those with noncardiogenic stroke (29). The difference was not significant, but the trend was concordant to previous reports.…”

Section: Cha 2 Ds 2 -Vasc Score and Laa Evaluationsupporting

confidence: 70%

Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients

Inoue

Suematsu

2019

J. Thorac. Dis.

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Background: In atrial fibrillation (AF) patients, the left atrial appendage (LAA) is the major source of thrombi. We assessed the hypothesis that poor contrast enhancement in the LAA during the early phase of cardiac computed tomography (CT) predicts a high risk of thrombus formation, leading to cardiogenic stroke. Methods: We studied 147 consecutive patients with chronic AF who underwent cardiac CT. Three different patterns of medium contrast enhancement in the LAA were used to categorize the stroke risk: poor, intermediate, and good enhancement pattern. Results: The CT scans of 147 patients were analyzed (age, 69±9 years; 82% men; 43% with a CHA 2 DS 2-VASc score ≥2). Seventy-two patients (49%) had a poor enhancement LAA enhancement pattern, 33 (22%) had an intermediate enhancement pattern, and 42 (29%) had a good enhancement pattern. Of the 147 patients, 58 (39%) had a history of ischemic stroke or transient ischemic attack (TIA). The prevalence of a stroke history associated with each pattern was 58%, 27%, and 17%, respectively (P<0.001). After controlling for the CHADS 2 or CHA 2 DS 2-VASc score and the ejection fraction using a multivariable logistic model, the poor enhancement pattern was found to be significantly more likely to be associated with a stroke history than other patterns [odds ratio (OR): 5.3; 95% confidence interval (CI): 2.5-11.1; P<0.0001]. Conclusions: The LAA enhancement pattern observed using cardiac CT is associated with the risk of stroke. Poor enhancement in the LAA suggests a potential high risk of stroke.

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Section: Cha 2 Ds 2 -Vasc Score and Laa Evaluationsupporting

confidence: 70%

Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients

Inoue

Suematsu

2019

J. Thorac. Dis.

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“…This is a very subjective approach and even experienced cardiologists may not always agree when classifying a LAA into specific shape categories. In addition, there is a large variability in stroke occurrence within a given LAA shape category (Khurram et al, 2013 ; Nedios et al, 2014 ; Sanatkhani and Menon, 2017 ; Yaghi et al, 2018 ). This is consistent with the large variability of t m ( Figure 3C ) and LAA- ACI (data not shown) within each shape category and in LAA values that exist even within a given LAA shape category ( Figure 3C ).…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that patients with the chicken wing morphology are less likely to have a stroke. Although these results are promising, there is a large variability in stroke occurrence within a given LAA shape category (Khurram et al, 2013 ; Nedios et al, 2014 ; Sanatkhani and Menon, 2017 ; Yaghi et al, 2018 ). The subjective nature of LAA shape categorization may contribute to this variability.…”

Section: Introductionmentioning

confidence: 99%

Subject-Specific Calculation of Left Atrial Appendage Blood-Borne Particle Residence Time Distribution in Atrial Fibrillation

et al. 2021

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Atrial fibrillation (AF) is the most common arrhythmia that leads to thrombus formation, mostly in the left atrial appendage (LAA). The current standard of stratifying stroke risk, based on the CHA2DS2-VASc score, does not consider LAA morphology, and the clinically accepted LAA morphology-based classification is highly subjective. The aim of this study was to determine whether LAA blood-borne particle residence time distribution and the proposed quantitative index of LAA 3D geometry can add independent information to the CHA2DS2-VASc score. Data were collected from 16 AF subjects. Subject-specific measurements included left atrial (LA) and LAA 3D geometry obtained by cardiac computed tomography, cardiac output, and heart rate. We quantified 3D LAA appearance in terms of a novel LAA appearance complexity index (LAA-ACI). We employed computational fluid dynamics analysis and a systems-based approach to quantify residence time distribution and associated calculated variable (LAA mean residence time, tm) in each subject. The LAA-ACI captured the subject-specific LAA 3D geometry in terms of a single number. LAA tm varied significantly within a given LAA morphology as defined by the current subjective method and it was not simply a reflection of LAA geometry/appearance. In addition, LAA-ACI and LAA tm varied significantly for a given CHA2DS2-VASc score, indicating that these two indices of stasis are not simply a reflection of the subjects' clinical status. We conclude that LAA-ACI and LAA tm add independent information to the CHA2DS2-VASc score about stasis risk and thereby can potentially enhance its ability to stratify stroke risk in AF patients.

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“…3 Furthermore, the left atrial appendage has been classified in to 4 morphologies based on its radiographic appearance (in descending order of frequency): chicken wing, cactus, windsock and cauliflower. 3 The morphology of the left atrial appendage has been shown to be associated with the risk of embolization with pilot data suggesting that a "non-chicken-wing" morphology is most closely associated with embolic stroke (either ESUS or cardioembolic stroke) 5 , possibly mediated by a lower LAA peak flow velocity in patients with non-chicken wing morphology. The LAA can be challenging to visualize by TTE or transesophageal echocardiography (TEE) owing to its length and varied morphology.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Thrombus and Embolic Stroke

Grory¹,

Chang

Atalay³

et al. 2018

Stroke

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Left Atrial Appendage Morphology and Embolic Stroke of Undetermined Source: A Cross-Sectional Multicenter Pilot Study

Cited by 24 publications

References 13 publications

Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients

Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients

Subject-Specific Calculation of Left Atrial Appendage Blood-Borne Particle Residence Time Distribution in Atrial Fibrillation

Left Atrial Appendage Thrombus and Embolic Stroke

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