Left atrial appendage morphology and cardiac function in patients with sinus rhythm

Shimada, Megumi; Amaki, Makoto; Kobayashi, Takayuki

doi:10.1007/s12574-020-00462-0

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…The correlation in the LAA function with the axes, area, and perimeter of the LAA orifice and LAA depth has not been previously reported. Some researchers analyzed LAA morphologic types and functions ( 23 , 24 ). In our study, we found that the LAA emptying fraction was negatively correlated with the major axis and area of the LAA orifice but was not significantly correlated with LAA depth.…”

Section: Discussionmentioning

confidence: 99%

Morphological changes in the orifices of the left atrial appendage and left atrium in patients with atrial fibrillation

Tian¹,

Wang²,

Gao³

et al. 2022

Quant Imaging Med Surg

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Background: As an integral part of the left atrium (LA), the left atrial appendage (LAA) plays an important role in atrial fibrillation (AF). However, the relationship between LAA remodeling and AF has not been clearly defined. This retrospective case-control study aimed to assess the morphological and functional features of the LA and the LAA in AF patients using images obtained by computed tomography angiography (CTA).Methods: A total of 140 AF patients and 64 patients without AF or other cardiovascular diseases who underwent CTA scans between September 2016 and August 2017 were enrolled in this observational study as the experimental and the control groups, respectively. The major and minor axes, area, and perimeter of the LAA orifice, the LAA depth, and the volume of both the LAA and LA were analyzed. The data of the AF group and the control group were compared. The t-test was used to analyze the normally distributed data, and the Wilcoxon rank-sum test was used for abnormally distributed data. The best critical value of predictors of AF was calculated using receiver operating characteristic (ROC) curve analysis. The correlation of the LAA volume change with the major and minor axes, area, and perimeter of the LAA orifice, and the LAA depth were analyzed using the Pearson correlation coefficient. Results:The LAA orifice's minor axis, LAA volume, and LA volume were significantly greater (P=0.004, P=0.010, and P<0.001, respectively) in patients with AF than in those without AF. The LAA volume [95% confidence interval (CI): 1.01 to 1.30; P=0.038] and LA volume (95% CI: 1.03 to 1.07; P<0.001) were significantly independent predictors of AF. An LAA volume of 8.75 mL had the highest predictive value for AF [area under the curve (AUC), 0.612], with a sensitivity of 76.6% and a specificity of 48.6%. In contrast, an LA volume of 97.15 mL had the highest predictive value for AF (AUC, 0.771), with a sensitivity of 90.6% and a specificity of 53.6%. The change of LAA volume was positively weakly correlated with the area and perimeter of the LAA orifice (r=0.1703 and r=0.1378, respectively). The LAA emptying fraction was negatively correlated with the major axis and the area of the LAA orifice. The major and minor axes, area, and perimeter of the LAA orifice, and LAA depth were significantly greater in female than in male patients (P=0.003, P=0.003, P=0.001, P=0.019, and P<0.001, respectively). Conclusions:The AF patients had a longer minor axis of the LAA orifice than that of the control group, resulting in a more circular LAA orifice. The LAA orifice area and perimeter were positively correlated with LAA volume change. The LAA orifice major and minor axes, area, and perimeter, and the LAA depth of the female patients were significantly greater than those of their male counterparts in AF patients.

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Section: Discussionmentioning

confidence: 99%

Morphological changes in the orifices of the left atrial appendage and left atrium in patients with atrial fibrillation

Tian¹,

Wang²,

Gao³

et al. 2022

Quant Imaging Med Surg

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“…Assessment of LAA morphology using cardiac computed tomography was not performed in this study. Patients with AF with non‐chicken wing‐type LAA had a higher prevalence of stroke events, 14–16 and non‐chicken wing‐type LAA was associated with low LAA flow in patients with AF 16 . Furthermore, the assessment of LA function by means of computed tomography or magnetic resonance image or LA strain by means of speckle‐tracking strain was not part of this study.…”

Section: Discussionmentioning

confidence: 99%

Left atrial volume index as a predictor for left atrial appendage thrombus in patients with non‐valvular atrial fibrillation receiving appropriate oral anticoagulation therapy: A prospective multi‐center study

Shiraki,

Tsunamoto,

Onishi

et al. 2024

Echocardiography

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ObjectivesWe previously reported a higher left atrial volume index (LAVI) was independently associated with left atrial (LA) appendage (LAA) thrombus formation in 737 patients with non‐valvular atrial fibrillation (NVAF) receiving appropriate oral anticoagulation therapy. Since our previous study was a retrospective single‐center study, we designed and conducted a prospective multi‐center study to verify our findings for LAVI as a predictor of LAA thrombus in patients with NVAF receiving appropriate oral anticoagulation therapy.MethodsThis prospective multi‐center study comprised 746 consecutive patients with NVAF recruited between December 2021 and March 2023 from eight institutions in Japan, who were receiving appropriate oral anticoagulation therapy, had undergone transthoracic echocardiography and transesophageal echocardiography (TEE).ResultsLAA thrombi were observed in 21 patients (2.8%). The prevalence of LAA thrombus formation in patients with paroxysmal AF (PAF) was significantly lower than that in patients with non‐PAF (0.7% vs. 4.1%, p = .006). LAA thrombus formation was detected in none (0/171) of the patients with normal size LA (LAVI ≤ 34 mL/m2). The prevalence of LAA thrombus formation in patients with mildly dilated LA (LAVI: 34–49.9 mL/m2) was 2.1% (6/283), but that in PAF patients was low at 1.0% (1/104). Furthermore, this prevalence in patients with severely dilated LA (LAVI ≥ 50 mL/m2) was high at 5.1% (15/292).ConclusionsThe findings of this prospective multi‐center study are consistent with those of our previous study. Thus, the need for TEE prior to catheter ablation or electrical cardioversion can be determined by the level of LAVI.

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“…Studies have described that, in patients with AF, LAA flow velocity is significantly higher in chicken-wing-type LAAs than in other types, and this morphology has a lower spontaneous echo contrast prevalence [ 18 , 19 , 20 , 21 ]. In a cohort of patients with sinus rhythm (SR), Shimada et al demonstrated that chicken-wing morphology was associated with higher volume variability during the cardiac cycle than non-chicken-wing morphology was [ 22 ]. Qureshi et al constructed a flow dynamics model for different LAA morphologies to simulate clot formation during SR and AF [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Left Atrial Appendage Morphology and Clot Histology in Patients with Embolic Ischemic Stroke: An Exploratory Study

Lengvenis,

Drachneris,

Žurauskas

et al. 2024

JCM

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Background: Acute embolic ischemic stroke poses a significant healthcare challenge. Histological clot features’ variability among patients with acute ischemic stroke treated by mechanical thrombectomy has potential implications for determining treatment and etiology. This study investigated the clot histological feature differences among patients who experienced cardioembolic stroke and embolic stroke of undetermined source with different left atrial appendage (LAA) morphologies. Methods: We conducted a prospective observational study involving 79 patients with acute embolic ischemic stroke undergoing mechanical thrombectomy. Computed tomography angiography images were used to classify LAA morphologies. An artificial intelligence algorithm assessed the clot fibrin and red blood cell contents. Results: Patients with chicken-wing LAA morphology exhibited lower mean clot fibrin proportions than did those with non-chicken-wing morphology (p < 0.001). Linear regression analysis showed that chicken-wing LAA was significantly associated with a lower clot fibrin proportion (estimate, −0.177; 95% CI [−0.259, −0.096]; p < 0.001). The successful recanalization rate and first-pass effect between the groups did not differ significantly. Conclusions: The chicken-wing LAA morphological type is associated with lower clot fibrin contents, suggesting potentially different embolism mechanisms or diverse embolic sources, compared with the non-chicken-wing LAA types. Further studies are required to investigate this association.

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Left atrial appendage morphology and cardiac function in patients with sinus rhythm

Cited by 10 publications

References 23 publications

Morphological changes in the orifices of the left atrial appendage and left atrium in patients with atrial fibrillation

Morphological changes in the orifices of the left atrial appendage and left atrium in patients with atrial fibrillation

Left atrial volume index as a predictor for left atrial appendage thrombus in patients with non‐valvular atrial fibrillation receiving appropriate oral anticoagulation therapy: A prospective multi‐center study

Association between Left Atrial Appendage Morphology and Clot Histology in Patients with Embolic Ischemic Stroke: An Exploratory Study

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