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Published on: February 26, 2013
Left atrial appendage dimensions predict the risk of stroke/TIA in patients with atrial fibrillation
Roy Beinart1, E Kevin Heist, John B Newell
1Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA.
Insights
Left atrial appendage (LAA) dimensions measured by MRI/MRA can predict stroke and TIA risk in patients with atrial fibrillation (AF). This imaging technique aids in risk stratification for embolic events.
Area of Science:
- Cardiology
- Radiology
- Neurology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, primarily due to thrombus formation in the left atrial appendage (LAA).
- Identifying specific LAA features linked to stroke risk is crucial for effective patient management.
Purpose of the Study:
- To investigate the association between LAA morphology and dimensions and the risk of stroke or transient ischemic attack (TIA) in AF patients.
- To evaluate the utility of magnetic resonance imaging and angiography (MRI/MRA) in assessing these LAA features.
Main Methods:
- 144 patients with nonvalvular AF underwent pre-ablation MRI/MRA.
- Measurements included LAA volume, depth, neck dimensions (short and long axes), and number of lobes.
- Logistic regression analysis identified predictors of prior stroke/TIA.
Main Results:
- Patients with prior stroke/TIA were older and had higher LAA volume, depth, and neck dimensions compared to those without.
- Significant multivariable predictors of stroke/TIA included age, aspirin use, and LAA neck dimensions (short axis × long axis).
Conclusions:
- LAA dimensions derived from MRI/MRA are significant predictors of stroke/TIA in AF patients.
- LAA assessment via MRI/MRA can serve as a valuable adjunctive tool for stratifying embolic event risk in AF.
Unlabelled:
Risk of Stroke/TIA in Patients With Atrial Fibrillation.
Introduction:
Most strokes in patients with atrial fibrillation (AF) arise from thrombus formation in left atrial appendage (LAA). Our aim was to identify LAA features associated with a higher stroke risk in patients with AF using magnetic resonance imaging and angiography (MRI/MRA).
Methods:
The study included 144 patients with nonvalvular AF who were not receiving warfarin and who underwent MRI/MRA prior to catheter ablation for AF. LAA volume, LAA depth, short and long axes of LAA neck, and numbers of lobes were measured.
Results:
Of the 144 patients, 18 had a prior stroke or transient ischemic attack (TIA) (13 and 5, respectively). Compared with patients who had no history of stroke/TIA, these patients were older, had higher prevalence of hypertension and hyperlipidemia and had higher LAA volume (22.9 ± 9.6 cm(3) vs. 14.5 ± 7.1 cm(3) , P < 0.001). Their LAA depth (3.76 ± 0.9 cm vs. 3.21 ± 0.8 cm, P = 0.006) and the long and short axes of the LAA neck (3.12 ± 0.7 cm vs. 2.08 ± 0.7 cm, P < 0.001; 2.06 ± 0.5 cm vs. 1.37 ± 0.4 cm, P < 0.001, respectively) were larger. Using stepwise logistic regression model, the only statistically significant multivariable predictors of events were age (OR = 1.21 per year, 95% CI 1.06-1.38, P = 0.004), aspirin use (OR = 0.039, 95% CI 0.005-0.28, P = 0.001), and LAA neck dimensions (short axis × long axis) (OR = 3.59 per cm(2) , 95% CI 1.93-6.69, P < 0.001).
Conclusion:
LAA dimensions predict strokes/TIAs in patients with AF. LAA assessment by MRI/MRA can potentially be used as an adjunctive tool for risk stratification for embolic events in AF patients.
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