Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke

Area of Science:

• Cardiology
• Neurology
• Radiology

Background:

• Cardioembolic (CE) stroke risk stratification traditionally uses qualitative left atrial appendage (LAA) morphology and atrial dysfunction biomarkers.
• Quantitative LAA properties influencing CE stroke risk remain underexplored.

Purpose of the Study:

• To investigate if quantitative LAA volume and contrast density (attenuation) on computed tomography (CT) correlate with CE stroke risk.
• To determine the association of LAA volume and density with CE stroke and Embolic Stroke of Undetermined Source (ESUS) subtypes.

Main Methods:

• Analysis of prospective ischemic stroke database including 311 patients with contrast-enhanced chest CT.
• Measurement of LAA volume and attenuation from CT scans.
• Univariate and multivariable analyses to identify factors associated with stroke subtypes.

Main Results:

• CE stroke subtype showed an association with LAA volume and density in unadjusted models.
• In adjusted models, only LAA density remained significantly associated with CE stroke (aOR 3.71).
• No significant association was found between LAA measures and ESUS subtype.

Conclusions:

• LAA volume and density on CT are associated with CE stroke, but not ESUS.
• Increased LAA volume or density in ESUS patients may indicate a CE mechanism, suggesting a potential role for anticoagulation therapy in secondary stroke prevention.