Association of Left Atrial Appendage Morphology and Function With Stroke and Transient Ischemic Attack in Atrial Fibrillation Patients

• Published in: The American journal of cardiology 2024-06, Vol.221, p.37-43
• Main Authors: Simon, Judit, Smit, Jeff M., El Mahdiui, Mohammed, Száraz, Lili, van Rosendael, Alexander R., Zsarnóczay, Emese, Nagy, Anikó Ilona, Gellér, Lászlo, van der Geest, Rob J., Bax, Jeroen J., Maurovich-Horvat, Pál, Merkely, Béla
• Format: Article
• Language: English
• Subjects: Ablation; Appendages; atrial fibrillation; Blood clots; Cardiac arrhythmia; cardiac computed tomography angiography; Cardiovascular disease; Catheters; Computed tomography; Echocardiography; Ejection fraction; Fibrillation; Flow velocity; Health risks; Heart; Heart failure; Hyperlipidemia; Ischemia; left atrium; Medical instruments; Morphology; Orifices; Regression analysis; Risk factors; Software; Stroke; Structure-function relationships; Transient ischemic attack; Velocity
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.03.025

We aimed to correlate left atrial appendage (LAA) structure and function with the history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation (AF). We analyzed the data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent cardiac computed tomography and transesophageal echocardiography before ablation. The LAA morphologies depicted by cardiac computed tomography were categorized into 4 groups: cauliflower, chicken wing, swan, and windsock shapes. The mean age was 61.3 ± 10.5 years, 33.9% were women. The prevalence of stroke/TIA was 7.1%. After adjustment for the main risk factors, the LAA flow velocity ≤35.3 cm/s (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.09 to 4.61, p = 0.033) and the swan LAA shape (OR 2.69, 95% CI 0.96 to 6.86, p = 0.047) independently associated with a higher risk of stroke/TIA, whereas the windsock LAA morphology proved to be protective (OR 0.32, 95% CI 0.12 to 0.77, p = 0.017) compared with the cauliflower LAA shape. Comparing the differences between the LAA morphology groups, we measured a significantly smaller LAA orifice area (389.3 ± 137.7 mm2 in windsock vs 428.3 ± 158.9 ml in cauliflower, p = 0.021) and LAA volume (7.4 ± 3.0 mm2 in windsock vs 8.5 ± 4.8 mm2 in cauliflower, p = 0.012) in patients with windsock LAA morphology, whereas the LAA flow velocity did not differ significantly. Reduced LAA function and swan LAA morphology were independently associated with a higher prevalence of stroke/TIA, whereas the windsock LAA shape proved to be protective. Comparing the differences between the various LAA morphology types, significantly lower LAA volume and LAA orifice area were measured in the windsock LAA shape than in the cauliflower LAA shape.