Abstract
ObjectivesLeft atrial appendage (LAA) dilatation and morphology may influence an individual's risk for intracardiac thrombi and ischemic stroke. LAA size and morphology can be evaluated using cardiac computed tomography (cCT). The present study evaluated the reproducibility of LAA volume and morphology assessments.MethodsA total of 149 patients (47 females; mean age 60.9±10.6 years) with suspected cardioembolic stroke/transient ischemic attack underwent cCT. Image quality was rated based on four categories. Ten patients were selected from each image quality category (N = 40) for volumetric reproducibility analysis by two individual readers. LAA and left atrium (LA) volume were measured in both two-chamber (2CV) and transversal view (TV) orientation. Intertechnique reproducibility was assessed between 2CV and TV (200 measurement pairs). LAA morphology (A = Cactus, B = ChickenWing, C = WindSock, D = CauliFlower), LAA opening height, number of LAA lobes, trabeculation, and orientation of the LAA tip was analysed in all study subjects by three individual readers (447 interobserver measurement pairs). The reproducibility of volume measurements was assessed by intra-class correlation (ICC) and the reproducibility of LAA morphology assessments by Cohen's kappa.ResultsThe intra-observer and interobserver reproducibility of LAA and LA volume measurements was excellent (ICCs>0.9). The LAA (ICC = 0.954) and LA (ICC = 0.945) volume measurements were comparable between 2CV and TV. Morphological classification (ĸ = 0.24) and assessments of LAA opening height (ĸ = 0.1), number of LAA lobes (ĸ = 0.16), trabeculation (ĸ = 0.15), and orientation of the LAA tip (ĸ = 0.37) was only slightly to fairly reproducible.ConclusionsLA and LAA volume measurements on cCT provide excellent reproducibility, whereas visual assessment of LAA morphological features is challenging and results in unsatisfactory agreement between readers.
Highlights
Stroke is the leading cause of long-term disability and the second highest cause of mortality globally [1]
Recent magnetic resonance imaging (MRI) studies have shown that left atrial appendage (LAA) volume is strongly associated with an increased prevalence of prior stroke/transient ischemic attack (TIA), and the risk differs between LAA morphologies [12,13]
Image quality was rated as excellent in 22 (61%), good in 8 (22%), moderate in 6 (17%), and poor in 0 (0%) of the 36 patients imaged with the 64-slice scanner, and in 8 (7%), 34 (30%), 45 (40%), and 26 (23%) of the 113 patients imaged with the 16-slice scanner, respectively
Summary
Stroke is the leading cause of long-term disability and the second highest cause of mortality globally [1]. The role of LAA enlargement in the etiology of these strokes may be underestimated, and cryptogenic stroke/TIA has been associated with enlarged LAA volumes [5,6]. The role of the LAA in thrombus formation and stroke risk has been studied using multiple imaging modalities [7,8,9,10,11,12,13]. Recent magnetic resonance imaging (MRI) studies have shown that LAA volume is strongly associated with an increased prevalence of prior stroke/TIA, and the risk differs between LAA morphologies [12,13]. 2D transesophageal echocardiography (TEE) is currently the most commonly used imaging modality for preoperative assessment, the use of 3D approaches have shown to provide additive information in cases of complex morphology of the LAA [17]
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