Impact of left atrial appendage morphology on thrombus formation in TAVI patients with atrial fibrillation

• Published in: European journal of medical research 2023-02, Vol.28 (1), p.88-88, Article 88
• Main Authors: Abanador-Kamper, N, Bepperling, J, Seyfarth, M, Haage, P, Kamper, L
• Format: Article
• Language: English
• Subjects: Age; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic valve stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Atrial Appendage - diagnostic imaging; Atrial Fibrillation; Blood clot; Blood clots; Cardiac arrhythmia; Comparative analysis; CT imaging; Diabetes; Heart failure; Humans; Hypertension; Left atrial appendage; Medical imaging; Morphology; Pacemakers; Risk assessment; Stroke; Thromboembolism; Thrombosis; Thrombosis - diagnostic imaging; Thrombosis - epidemiology; Thrombosis - etiology; Thrombus; Transient ischemic attack
• ISSN: 2047-783X; 0949-2321; 2047-783X
• DOI: 10.1186/s40001-023-01057-y

We aimed to correlate left atrial appendage (LAA) morphology with thrombus formation in patients with severe aortic valve stenosis and atrial fibrillation. We analyzed LAA morphology and the prevalence of a thrombus in 231 patients with atrial fibrillation and severe aortic valve stenosis that were referred for pre-interventional CT scan before trans-catheter aortic valve implantation (TAVI) between 2016 and 2018. In addition, we documented neuro-embolic events depending on the presence of LAA thrombus within a follow-up of 18 months. The overall distribution of different LAA morphologies was chicken-wing 25.5%, windsock 51.5%, cactus 15.6% and cauliflower 7.4%. Compared to chicken-wing morphology, patients with non-chicken-wing morphology showed a significantly higher thrombus rate (OR: 2.48, 95%; CI 1.05 to 5.86, p = 0.043). Within the 50 patients with a LAA thrombus, we observed chicken-wing (14.0%), windsock (62.0%), cactus (16.0%) and cauliflower (8.0%) configuration. In patients with LAA thrombus those with chicken-wing configuration have a higher risk (42.9%) to develop neuro-embolic events compared to non-chicken-wing configuration (20.9%). We found a lower LAA thrombus rate in patients with chicken-wing morphology compared to patients with non-chicken-wing configuration. However, in the presence of thrombus, those patients with chicken-wing morphology showed a doubled risk for neuro-embolic events compared to patients with non-chicken-wing morphology. These results must be confirmed in larger trials but underline the importance of LAA evaluation in thoracic CT scans and could have an impact on the anticoagulation management.