Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation

Khurram, Irfan M.; Dewire, Jane; Mager, Michael; Maqbool, Farhan; Zimmerman, Stefan L.; Zipunnikov, Vadim; Beinart, Roy; Marine, Joseph E.; Spragg, David D.; Berger, Ronald D.; Ashikaga, Hiroshi; Nazarian, Saman; Calkins, Hugh

doi:10.1016/j.hrthm.2013.09.065

Cited by 187 publications

(136 citation statements)

References 26 publications

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“…25) In our study, the increase in LAA length was greater in AF patients with stroke than in the nonstroke group patients; but the difference was statistically insignificant (Table I). Anticoagulation management: The CHADS2 score was introduced into guidelines and implemented into clinical practice to assess individual thromboembolic risk in patients with AF.…”

Section: Discussionmentioning

confidence: 41%

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

et al. 2015

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SummaryThe left atrial appendage (LAA) represents one of the major sources of cardiac thrombi responsible for embolic stroke in patients with atrial fibrillation (AF). The aim of the present study was to evaluate LAA structure and functions by transesophageal echocardiography (TEE) in patients with AF to investigate the possible association between the different LAA morphologies and the patients' history of ischemic cerebral stroke. We included 50 patients with non-valvular AF (29 chronic, 21 paroxysmal), 24 patients (13 men) without stroke; and 26 patients (9 men) with a history of ischemic stroke. All patients underwent TEE evaluation of LAA morphology and functions. Compared to patients without stroke, patients with ischemic stroke had significantly higher CHADS2 scores (4.19 ± 0.89 versus 1.67 ± 1.13; P < 0.001) and C-reactive protein levels (8.3 ± 1.6 versus 7.6 ± 0.83 mg/L; P = 0.023), and lower peak filling (21.7 ± 11.3 versus 31.2 ± 9.5 cm/second; P = 0.033) and emptying (22.2 ± 9.7 versus 33.4 ± 13.4 cm/second, P = 0.030) velocities. Triangular LAA morphology had a higher prevalence in patients with stroke (36% versus 12% in non-stroke group); and in half of them an LAA thrombus was present. LAA thrombi were detected in 9 patients (18%) with stroke and in 5 patients (10%) Approximately 33% of arrhythmiarelated hospitalizations are for AF, which is also associated with a 5-fold increase in the risk of stroke and 2-fold increase in the risk of all cause mortality. 1) AF causes 15-20% of ischemic strokes, and the annual risk of stroke in patients with nonvalvular AF is as high as 5%.2)The left atrial appendage (LAA) has been described as a long, narrow, tubular, wavy, hooked structure with different lobes and a narrow junction and crenellated lumen. 3,4) As the LAA represents one of the major sources of cardiac thrombus formation responsible for stroke in patients with AF, 5,6) the imaging of the different structures and lobes is of utmost importance to diagnose the presence of thrombus, especially in patients with non-valvular AF. 7,8) Multidetector computed tomography 9) and contrast-enhanced magnetic resonance imaging 10) are able to image the LAA; however, it was concluded that magnetic resonance imaging lacks diagnostic accuracy for the detection of LAA thrombi.10) Transesophageal echocardiography (TEE) is the gold standard to detect LAA thrombus, 11) but false positive results still occur.12) In this study, we evaluated the LAA structure and functions by TEE in patients with non-valvular AF (both chronic and paroxysmal types) to study the possible association between the different LAA morphologies and functional changes with the patients' history of ischemic cerebral stroke. MethodsStudy design and participants: This study was conducted on 50 patients with non-valvular AF; including both chronic (29 patients, 58%) and paroxysmal (21 patients, 42%) cases. We included patients with documented paroxysmal AF because large, prospective studies have shown that the risk for thromboembolism does not differ ...

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Section: Discussionmentioning

confidence: 41%

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

et al. 2015

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“…This was confirmed in a recent meta-analysis [28]. Large LAA neck diameter and LAA depth as well as extensive LAA trabeculations may also be predictors of thromboembolic events [29]. Accurate assessment of the anatomic LAA characteristics is crucial before an LAA occlusion procedure as variations in LAA anatomy may impact device selection and procedure strategy.…”

Section: International Journal Of Cardiovascular Practicementioning

confidence: 85%

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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“…In a Japanese study of 564 patients with 3D-TEE, left atrial volume and number of LAA lobes were independently associated with LAA thrombus, with 94% (32/34) of those with thrombus having 3 or more lobes. 98 In contrast, LAA ostial size has been associated with both an increased 32 and decreased 97 …”

Section: Left Atrial Appendage Morphology and Microstructure Complexitymentioning

confidence: 98%

Left Atrial Appendage Exclusion for Atrial Fibrillation

Syed

DeSimone

Friedman

et al. 2016

Heart Failure Clinics

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Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation

Cited by 187 publications

References 26 publications

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

Role of Imaging in Left Atrial Appendage Occlusion

Left Atrial Appendage Exclusion for Atrial Fibrillation

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