Does the Left Atrial Appendage Morphology Correlate With the Risk of Stroke in Patients With Atrial Fibrillation?

Biase, Luigi Di; Santangeli, Pasquale; Anselmino, Matteo; Mohanty, Prasant; Salvetti, Ilaria; Gili, Sebastiano; Horton, Rodney; Sánchez, Javier; Bai, Rong; Mohanty, Sanghamitra; Pump, Agnes; Brantes, Mauricio Cereceda; Gallinghouse, G. Joseph; Burkhardt, J. David; Cesarani, Federico; Scaglione, Mariano; Natale, Andrea; Gaïta, Fiorenzo

doi:10.1016/j.jacc.2012.04.032

Cited by 701 publications

(555 citation statements)

References 24 publications

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“…Patients with chicken wing LAA morphology were shown to less likely develop an embolic event even after controlling for comorbidities and CHADS 2 score [27]. This was confirmed in a recent meta-analysis [28].…”

Section: International Journal Of Cardiovascular Practicementioning

confidence: 67%

Role of Imaging in Left Atrial Appendage Occlusion

Lempereur

Aminian

Potter

et al. 2017

ijcp

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Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to longterm oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure.

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Section: International Journal Of Cardiovascular Practicementioning

confidence: 67%

Role of Imaging in Left Atrial Appendage Occlusion

Lempereur

Aminian

Potter

et al. 2017

ijcp

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“…Likewise LAA morphology has been proposed as another marker of thromboembolism with the 'cauliflower' LAA conferring the highest risk of thrombus. In contrast patients with a 'chickenwing' appearance LAA have lowest risk of embolism [7].…”

Section: The Laa In Diseasementioning

confidence: 97%

“…The LAA varies considerably in size from 16-51mm in length, 10-40mm in diameter and 0.77-19.27cm 3 in volume [5,6]. The LAA also appears to differ in morphology with distinct variants including the 'chicken wing', 'cactus', 'windsock' and 'cauliflower' being described in 48%, 30%, 19% and 3% of cases respectively [7].…”

Section: Laa Anatomymentioning

confidence: 99%

The Left Atrial Appendage in Health and Disease

Howlett¹

2015

MOJAP

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Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia and results in significant morbidity and mortality. The left atrial appendage (LAA), a small embryonic remnant of the left atrium (LA), has been shown to play a key role in the pathophysiology of AF-related stroke and thromboembolism. As a consequence the LAA, in spite of its meagre size, has been described as 'our most lethal human attachment'. Despite being a recognised harbinger of disease, the LAA has also been shown to play an important role in health. This review seeks to address our current understanding of this vital structure in both health and disease states.

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“…Peak velocity of the LA appendage on TEE 48 LA fibrosis detected by DE-MRI 49 Atrial electromechanical interval on TTE 50 Chicken wing LA appendage morphology (protective effect) 51 LA appendage dimension The risk of AF-related stroke was higher in Caucasian populations than in Asians populations. [9][10][11][12][13][14][15] enhanced magnetic resonance imaging, in predicting TE events in AF.…”

Section: Imaging Toolsmentioning

confidence: 99%

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Chao

Chiang

Chen

2013

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, accounting for approximately one-third of hospitalisations for cardiac rhythm disturbances.1 Between 1980 and 2000, the age-adjusted incidence of AF significantly increased from 3.04 to 3.68 per 1,000 person-years in the US. 2 The prevalence of AF was lower among African Americans than among Caucasians, 3 and it also seemed to be lower in the Asian population. 4,5 In a nationwide cohort of 702,502 participants in Taiwan, the AF incidence was around 1.5 per 1,000 person-years. 6 Since a considerable number of AF patients was paroxysmal in nature, the incidence and prevalence of AF could be significantly underestimated.Systemic thromboembolism is the most severe complication of AF. It accounts for about 15-20 % of ischaemic strokes.7 AF-related strokes were associated with a poor prognosis as more than 50 % of the survivors remain with a severe deficit, and recurrence may be as high as 12 % per year. 8 The risk of AF-related stroke was higher in Caucasian populations than in Asians populations (see Figure 1). 4,[9][10][11][12][13][14][15] AF could in fact drive a prothrombotic or hypercoagulable state, by virtue of its fulfilment of Virchow's triad for thrombogenesis (blood stasis, endocardial dysfunction/damage, and abnormal haemostasis). The most important point in determining the strategy of stroke prevention for AF is how to estimate the thromboembolic (TE) risk accurately. The CHADS 2 score is the most commonly used scheme in stroke risk stratifications for AF patients, 17 despite the fact that it classifies a large proportion of patients as being at 'intermediate risk', and several important TE risk factors were omitted in the scoring system. 18 Recently, a newly developed scoring system, CHA 2 DS 2 -VASc score, which extends the CHADS 2 scheme by considering additional stroke risk factors (vascular diseases and female gender) was recommended to be used to guide the antithrombotic therapies for AF patients. 19,20 The CHA 2 DS 2 -VASc score is most useful in identifying truly low-risk patients, and no antithrombotic therapy is necessary for patients with a CHA 2 DS 2 -VASc score of 0. [21][22][23] In the study performed by Taillandier et al., which enrolled a total of 616 AF patients with a CHA 2 DS 2 -VASc score of 0, an OAC was prescribed on an individual basis in 273 patients (44 %), antiplatelet therapy alone in 145 patients (24 %), and no antithrombotic therapy in 198 patients (32 %).22 During a follow-up of 876 ± 1,135 days, 38 patients experienced adverse events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Prescription of OACs and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk: 0.99, 95 % confidence interval: 0.25-3.99, p-value: 0.99), nor improved survival or net clinical benefit (combination of stroke/ thromboembolism, bleeding and death). More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 ...

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Does the Left Atrial Appendage Morphology Correlate With the Risk of Stroke in Patients With Atrial Fibrillation?

Abstract: This study investigated the left atrial appendage (LAA) by computed tomography (CT) and magnetic resonance imaging (MRI) to categorize different LAA morphologies and to correlate the morphology with the history of stroke/transient ischemic attack (TIA).

Cited by 701 publications

References 24 publications

Role of Imaging in Left Atrial Appendage Occlusion

Role of Imaging in Left Atrial Appendage Occlusion

The Left Atrial Appendage in Health and Disease

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

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