Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation

Fukushima, Keiko; Fukushima, Noritoshi; Kato, Ken; Ejima, Koichiro; Sato, Hiroki; Fukui, Kenji; Saito, Chihiro; Hayashi, Keiko; Arai, Kotaro; Manaka, Tetsuyuki; Ashihara, Kaoru; Shoda, Morio; Hagiwara, Nobuhisa

doi:10.1093/ehjci/jev117

Cited by 59 publications

(48 citation statements)

References 29 publications

(33 reference statements)

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“…In contrast to this study, and its largely non-AF patient population, the majority of previous LAA morphological studies have focused on subjects with AF [18–20]. As far as we are aware, this is the most extensive study to explore LAA morphology in a non-AF population.…”

Section: Discussionmentioning

confidence: 96%

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

et al. 2017

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The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.

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Section: Discussionmentioning

confidence: 96%

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

et al. 2017

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“…31 Furthermore, cauliflower LAA morphology was an independent predictor of stroke risk, presumably related to extensive LAA trabeculations. 32 LAA flow velocity, another inverse marker of stroke risk, was highest among patients with chicken-wing as opposed to non-chicken wing morphology, 28, 33, 34 which may also explain why chicken wing morphology has the lowest risk of ischemic stroke. In addition, larger LAA orifice area has also been shown to be associated with ischemic stroke.…”

Section: Atrial Cardiopathy: Rationale and Biological Mechanismsmentioning

confidence: 97%

Atrial cardiopathy: a mechanism of cryptogenic stroke

Yaghi

Kamel

Elkind

2017

Expert Review of Cardiovascular Therapy

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Introduction Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes. Areas covered This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial cardiopathy, critically review data on biomarkers of atrial cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research. Expert commentary Atrial cardiopathy may constitute one of the mechanisms in cryptogenic stroke, and patients with evidence of atrial cardiopathy constitute a group of patients in whom clinical trials are warranted to test anticoagulation versus antiplatelet therapy to reduce stroke recurrence risk. In addition, more studies are needed to determine the degree of overlap between these atrial cardiopathy biomarkers and which one is more useful in predicting the risk of stroke and response to anticoagulation therapy.

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“…48 Furthermore, cauliflower LAA morphology was an independent predictor of stroke which is possibly related to extensive LAA trabeculations. 49 LAA flow velocity was highest among patients with chicken-wing as opposed to non-chicken wing morphology 29, 51, 52 which may explain why chicken wing morphology has the lowest risk of ischemic stroke. In addition, larger LAA orifice area has also been shown to be associated with ischemic stroke (Table).…”

Section: Left Atrial Appendage Function and Morphology In Relation Tomentioning

confidence: 98%

Left Atrial Appendage Function and Stroke Risk

Yaghi

Song

Gray

et al. 2015

Stroke

138

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Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation

Abstract: LAA morphology is a significant determinant of LAAFV, suggesting an underlying mechanism for the association between LAA morphology and embolic events.

Cited by 59 publications

References 29 publications

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

Atrial cardiopathy: a mechanism of cryptogenic stroke

Left Atrial Appendage Function and Stroke Risk

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