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Published on: February 26, 2013
The predictive value of a concise classification of left atrial appendage morphology to thrombosis in non-valvular
Jionghong He1, Zenan Fu1,2, Long Yang1
1Cardiology Department, Guizhou Provincial People's Hospital, Guiyang City, China.
Insights
Complex left atrial appendage (LAA) morphology is a significant independent risk factor for LAA thrombosis in nonvalvular atrial fibrillation (NVAF) patients. This classification method aids in assessing stroke risk.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- Left atrial appendage (LAA) complexity in nonvalvular atrial fibrillation (NVAF) patients is linked to thrombosis and stroke.
- Current LAA morphology classification methods lack uniformity and are debated.
Purpose of the Study:
- To investigate the association between LAA structural complexity and thrombosis risk in NVAF patients.
- To categorize LAA morphology into simple and complex types for risk assessment.
Main Methods:
- 336 NVAF patients were categorized into thrombosis and non-thrombosis groups.
- Computer-aided 3D reconstruction was used for LAA morphology analysis.
- Imaging experts classified LAA morphology as simple or complex based on lobulation.
Main Results:
- Complex LAA morphology was independently associated with a 4.168-fold increased risk of LAA thrombus (OR 4.168, 95% CI 1.871-9.288, P < .001).
- The classification method showed high inter-rater reliability (96.4%).
- Complex LAA morphology emerged as a significant independent risk factor for LAA thrombosis.
Conclusions:
- Classifying LAA morphology as simple or complex based on lobulation is a reliable method.
- Complex LAA morphology is a confirmed independent risk factor for LAA thrombosis in NVAF patients.
Background:
The complexity of left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF) is closely related to LAA thrombosis and stroke incidence. But the classification of LAA morphology is not uniform and controversial.
Hypothesis:
This study divided the LAA into two categories according to the LAA morphology to investigate the risk of thrombosis related to the LAA structural complexity in NVAF patients.
Methods:
A total of 336 NVAF patients were enrolled continuously in this study. The patients were divided into thrombosis group and non-thrombosis group according to whether the thrombus presence in LAA. Through computer LAA three-dimensional reconstruction, LAA morphology was divided into the complex type and simple type according to with or without the clearly lobulated structure judged by imaging experts. The relationship between LAA thrombosis and various potential risk factors was analyzed.
Results:
A total of 19 potential risk factors for LAA thrombosis in NVAF patients were enrolled into statistical analysis. The coincidence rate of LAA morphology classification was 96.4% (324/336) between two imaging experts. Multivariate logistic regression analysis showed that complex LAA morphology (OR 4.168, 95% CI 1.871-9.288, P < .001) was associated with the presence of LAA thrombus, independently of other enrolled risks.
Conclusions:
It is a concise and reliable method to divide the LAA morphology into complex type and simple type according to whether with the clearly lobulated structure. The complex LAA is an independent risk factor for LAA thrombosis in NVAF patients.
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