Left Atrial Appendage (LAA) Morphology for Prediction of Embolic Stroke in Atrial Fibrillation (AF)

Heart Imagery
September 13, 2016 —

Problems to Solve

Although the morphology of the LAA is extremely complex and heterogeneous, it does not dramatically change over time in patients with AF. We proposed a new morphologic classification for the LAA mainly based on the presence or absence of an evident or obvious “bend.”

Our Approach

Background

●     The Chicken Wing LAA has an apparent bend in the proximal or middle part of the dominant lobe

●     The Cactus LAA has a dominant central lobe with secondary lobes extending from the central lobe in both superior and inferior directions

●     The Windsock LAA has one dominant lobe of sufficient length as the primary structure with variations of this LAA type based on the location and number of secondary or even tertiary lobes arising from the dominant lobe

●     The Cauliflower LAA has limited overall length with more complex internal characteristics

●     Variations of this LAA type have a more irregular shape of the LAA ostium (oval vs. round) as well as a variable number of lobes that lack of a dominant lobe


Study

●     A large multicenter study sought to correlate these four LAA morphologies, as obtained with CT or cardiac MRI images, with the risk of prior CVA in AF patients

●     Patients with Chicken Wing LAA morphology had a statistically significant lower risk of previous stroke when compared with all the remaining LAA morphology described

●     Non–Chicken Wing LAA morphology increases the risk of prior stroke/TIA more than 6-fold compared with Chicken Wing (OR 10.1, 95%, p=0.019) in patients with CHADS 2 score 0 to 1

●     This also holds true with patients with AF with silent or asymptomatic ischemic stroke



Di Biase L, Santangeli P, Anselmino M, Mohanty P, Salvetti I, Gili S, Horton R, Sanchez JE, Bai R, Mohanty S, Pump A, Cereceda Brantes M, Gallinghouse GJ, Burkhardt JD, Cesarani F, Scaglione M, Natale A and Gaita F. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. Journal of the American College of Cardiology. 2012;60:531-8.

Florentino Lupercio, M.D, Juan Carlos Ruiz, MD, David F. Briceno, M.D, Jorge Romero, M.D, Pedro A. Villablanca M.D, Robert Fallaice, MD, Andrew Krumerman, M.D, John D. Fisher, MD, Kevin Ferrick, MD, Mario Garcia, MD, Andrea Natale, MD, Luigi Di Biase MD, PhD. Left Atrial Appendage Morphology Assessment for Risk Stratification of Embolic Stroke in Patients with Atrial Fibrillation. A Meta-Analysis. Submitted to 
Heart Rhythm Journal 2016

View Article on Pubmed