A Morphological Study of Left Atrial Appendage in Egyptian patients Using multidetector computed tomography (MDCT)

Abstract

Abstract Background The most common etiology of stroke is known to be cardio- embolic type and left atrial appendage is the site of origin of thrombi in 90% of cardio embolic stroke .Most literature reports that left atrial appendage thrombi tend to be more common in females and black people1. In the past, the left atrial appendage (LAA) has been considered to be a relatively insignificant portion of cardiac anatomy. It is now recognized that it is a structure with important pathological associations as thrombus has a predilection to form within the LAA in patients with non-valvar atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm). The exact pathogenesis of thrombus formation inside left atrial appendage is still not fully elucidated, but many literature suppose that the cause is the stagnation within the long, blind-ended trabeculaed pouch2 Objective to describe left atrial appendage morphology and identify the prevalence of its different subtypes in Egyptian patients. Material and Methods the study analyzed retrospectively the data of 100 consecutive Egyptian patients who underwent multidetector computed tomography (MDCT) at Ain shams university specialized hospital from August 2019 to February 2020.Axial source images, two and threedimensional data sets were evaluated for each of the patients .All images were analyzed by a qualified cardiologist using dedicated software called “Horos Workstation”, and were blinded to patient data. All images were assessed and evaluated for LAA morphology and volume and were categorized according to the classification of Wang et al. 2010. Results windsock morphology existed in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of patients whereas 20% of patients had cactus morphology. There was significant gender difference in LAA morphology where female patients had more cauliflower and cactus morphology as compared to male gender (p < 0.05). Left atrial appendage volume showed a statistically significant positive correlation with advanced age and significant negative correlation with Left ventricular ejection fraction. Conclusion Egyptian patients had predominantly windsock morphology in males and cactus morphology in females.