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Related Experiment Video

Updated: Nov 23, 2025

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Malignant Left Atrial Appendage Morphology: Current Classification vs H-L System.

Paloma Parra-Díaz1, Luisa Salido-Tahoces2, Ana Pardo-Sanz2

  • 1Department of Neurology, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, Km 9100, Madrid 28034, Spain.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|January 2, 2021
PubMed
Summary

A new classification system for left atrial appendage (LAA) morphology, categorizing it as low-risk (LAA-L) or high-risk (LAA-H), shows promise in identifying stroke recurrence risk. High-risk LAA morphology is associated with larger left atrial size.

Keywords:
Cardioembolic strokeClassification systemMalignant left atrial appendageMorphologyThromboembolism

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Stroke Research

Background:

  • Left atrial appendage (LAA) morphology influences stroke recurrence risk, with specific shapes previously termed 'malignant'.
  • A simplified classification of LAA morphology into Low-risk (LAA-L) and High-risk (LAA-H) categories has been proposed.
  • This new system may offer improved clinical applicability and correlation with embolic stroke risk.

Purpose of the Study:

  • To evaluate a new, simplified classification system for left atrial appendage (LAA) morphology.
  • To determine the association between this new LAA morphology classification and the risk of recurrent cardioembolic strokes.
  • To assess the correlation between LAA morphology and left atrial (LA) size.

Main Methods:

  • Retrospective analysis of patients with recurrent cardioembolic strokes despite anticoagulation.
  • Cardiac CT scans were used to assess LAA morphology.
  • LAA morphology was classified using both traditional categories and the new LAA-L/LAA-H system. CHA 2 DS 2 -VASc score and LA size were also evaluated.

Main Results:

  • The new system classified 15 patients (57.7%) as LAA-H and 11 (42.3%) as LAA-L.
  • All non-chicken wing (NCW) morphologies were classified as LAA-H.
  • LAA-H morphology was significantly associated with increased LA diameter and area (p=0.03 and p=0.014, respectively).

Conclusions:

  • The proposed LAA morphology classification effectively identifies a high-risk group, with over half of previously identified 'malignant' LAA cases falling into the LAA-H category.
  • High-risk LAA morphology is linked to significantly larger left atrial dimensions.
  • This simplified classification may enhance the assessment of stroke recurrence risk based on LAA anatomy.