Abstract
The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.
Highlights
One in every four cases of ischemic stroke has an underlying cardioembolic mechanism [1]
Excluded patients included 3 who were less than 18 years of age, 3 because their left atrial appendage (LAA) could not be reliably assessed from the coronary artery computed tomography angiography (CCTA) image, and 2 patients who suffered atrial fibrillation (AF) during CCTA
The prevalence of LAA morphological classes and their relative LAA lengths were analyzed according to the classification criteria detailed in Tables 2 and 3, and illustrated in Figs 2 and 3
Summary
One in every four cases of ischemic stroke has an underlying cardioembolic mechanism [1]. This fraction may even be an underestimate given that this etiology remains cryptogenic in approximately 25% of all cases [2]. In 90% of cardiogenic strokes, the left atrial appendage (LAA) serves as the site for thrombus formation, prompting extensive medical research into this relatively small structure [3,4]. The identification of LAA features that might predispose to AF could serve as a useful predictive tool with which to identify patients at an increased risk for paroxysmal AF and, life-threatening cardiogenic stroke
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