PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

Left Atrial Appendage Morphology and Function Play an Important Role in the Prevalence of Stroke and Transient Ischemic Attack in Patients with Atrial Fibrillation

Text of the abstract

Aim
We aimed to correlate LAA structure and function with the history of stroke/TIA in patients with AF.
Method
We analyzed demographic and clinical data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent preablational cardiac computed tomography (CT) and transesophageal echocardiography. LAA morphologies depicted by cardiac CT were categorized into four groups: cauliflower, chicken wing, swan and windsock shapes. Uni- and multivariate logistic regression analyses were performed to examine the significant associates of stroke/TIA.
Results
Mean age was 61.3±10.5 years, 33.9% were female. Prevalence of stroke/TIA was 7.1%. The prevalence of cauliflower, windsock, chicken wing and swan morphologies were 50.2%, 32.5%, 12.4% and 4.8% in patients without prior stroke/TIA versus 63.0%. 13.0%, 8.7% and 15.2% in those with prior stroke/TIA, respectively (p=0.002). After adjustment for the main risk factors, LAA flow velocity ≤35.3 cm/sec (OR=2.18; 95%CI=1.09-4.61; p=0.033) and swan LAA shape (OR=2.69; 95%CI=0.96-6.86; p=0.047) independently associated with higher risk of stroke/TIA, while windsock LAA morphology proved to be protective (OR=0.32; 95%CI=0.12-0.77; p=0.017). When comparing the differences between LAA morphology groups, we measured significantly smaller LAA orifice area (389.3±137.7 mm2 in windsock type vs 428.3±158.9 ml in cauliflower type, p=0.021) and LAA volume (7.4±3.0 mm2 in windsock type vs 8.5±4.8 mm2 in cauliflower type, p=0.012) in patients with windsock LAA morphology, while LAA flow velocity did not differ significantly between the LAA shape groups.
Conclusion
In this retrospective study of 649 AF patients, reduced LAA function and swan LAA morphology independently associated with higher risk of stroke/TIA and windsock LAA shape proved to be protective. When comparing the differences between the various LAA morphology types, significantly lower LAA volume and LAA orifice area were measured in windsock LAA shape as compared to cauliflower.
Funding
Project no. NVKP_16-1–2016-0017 (’National Heart Program’); National Research, Development and Innovation Fund of Hungary; NVKP_16 funding scheme
Thematic Excellence Programme (2020-4.1.1.-TKP2020); Ministry for Innovation and Technology in Hungary; Therapeutic Development and Bioimaging thematic programmes; Semmelweis University.