Left atrial appendage morphology and function predict thromboembolic risk in patients with embolic stroke of undetermined sources

Abstract

Abstract Introduction Embolic stroke of undetermined sources (ESUS) is supposed to be associated with intracardiac thrombus formation, in particular in the left atrial appendage (LAA). We aimed to investigate the impact of LAA morphology and function on thromboembolic risk condition (TRC) and LAA thrombus in ESUS patients. Methods 185 ESUS patients (mean age 68 ±13 years, 33% female) without history of AF were included. All patients underwent clinical evaluation by CHA2DS2-VASc and complete transthoracic and transesophageal echocardiography shortly after index ESUS (4 days, IQR 3-6). LAA function and LAA morphology were evaluated by conventional 2D and 3D echocardiography and speckle tracking strain. TRC was defined as combination of thrombus, sludge and spontaneous echo contrast (SEC) in LAA. Results In 185 study patients, following LAA types were found: chicken wing (LAA CW) 79 (43%), windsock 64 (34%), cactus 35 (19%), cauliflower 7 (4%) and multilobate LAA, defined as LAA with ≥ 1 lobe, in 115 (62%) of patients. TRC was found in 123 (67%) and thrombus formation in 29 (16%). LAA CW and multilobate LAA were independent predictors of TRC (OR 2.3 (CI 1.2 - 4.5), p= 0. 01 and OR 2.2 (CI 1.2 - 4.2), p= 0.02, respectively) and furthermore, LAA CW and LAA-Sr were independent predictors of LAA thrombus (OR 2.5 (CI 1.1 - 5.8), p=0.04 and OR 0.9 (CI 0.8 – 1.0), p<0.01, respectively), all adjusted for CHA2DS2-VASc-score. Conclusion LAA type CW, multilobate LAA and novel LAA strain predicted independently TRC and LAA thrombus, respectively. These results indicate that LAA morphology and function are important in assessment of thromboembolic risk in ESUS patients.Table 1.