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Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic Ischemic Stroke

Indranill Basu-Ray1,2, Deepthi Sudhakar3, Gregory Schwing4

  • 1Texas Heart Institute, Houston, TX, United States.

Frontiers in Cardiovascular Medicine
|November 22, 2018
PubMed

Insights

Complex left atrial appendage (LAA) morphology may independently contribute to cryptogenic strokes. Chicken-wing LAA morphology showed higher flow rates in simulations, suggesting a potential mechanism for thromboembolism.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Ischemic strokes are a major health concern, with 20-40% having unknown causes.
  • Left atrial appendage (LAA) morphology is a potential, understudied factor in thromboembolic events.
  • Understanding LAA morphology's role in cryptogenic stroke is crucial.

Purpose of the Study:

  • To investigate the association between LAA morphology and cryptogenic stroke.
  • To compare LAA morphology in patients with atrial fibrillation-related stroke versus cryptogenic stroke.
  • To explore the functional implications of different LAA morphologies using computational models.

Main Methods:

  • Retrospective cross-sectional study analyzing transesophageal echocardiography (TEE) data.
  • Classification of LAA morphology into simple (chicken-wing) and complex (non-chicken wing) types.
  • Computational modeling to simulate blood flow dynamics within different LAA morphologies.

Main Results:

  • No significant differences in LAA volume, size, or velocities between simple and complex morphologies.
  • Complex LAA morphology was more prevalent in patients with cryptogenic stroke without atrial fibrillation.
  • Simulations indicated a four-fold higher flow rate in chicken-wing LAA morphology.

Conclusions:

  • Complex LAA morphology may be an independent risk factor for cryptogenic strokes.
  • The chicken-wing LAA morphology's unique flow dynamics warrant further investigation.
  • Elucidating the LAA morphology-thromboembolism link can improve stroke prevention strategies.

Keywords:
atrial fibrillationcomplex LAA morphologycryptogenic strokeleft atrial appendageleft atrial appendage closure

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