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Assessment of the left atrial appendage morphology in patients after ischemic stroke - The ASSAM study
Katarzyna Dudzińska-Szczerba1, Ilona Michałowska2, Roman Piotrowski3
1Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland.
Insights
The distance from the left atrial appendage (LAA) opening to its first bend is a key indicator of stroke risk in patients with atrial fibrillation (AF). This finding could help identify high-risk individuals for targeted prevention strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Stroke Research
Background:
- Atrial fibrillation (AF) is a significant risk factor for ischemic stroke.
- Left atrial appendage (LAA) morphology is increasingly recognized as a potential determinant of stroke risk in AF patients.
- The ASSAM study investigated the link between LAA anatomy and stroke in AF.
Purpose of the Study:
- To evaluate the association between left atrial appendage (LAA) morphology and stroke risk in patients with atrial fibrillation (AF).
- To identify specific LAA anatomical features that predict ischemic stroke in AF patients.
Main Methods:
- The ASSAM study included 85 AF patients with acute ischemic stroke and 84 AF patients without stroke.
- Computed tomography (CT) of the left atrium (LA) was performed for all participants to analyze LAA anatomy.
- Statistical analysis, including multivariable modeling, was used to identify stroke predictors.
Main Results:
- Patients with stroke had a larger LAA volume, greater distance from LAA ostium to the first bend, and a rounder LAA ostium shape.
- Multivariable analysis identified LAA ostium to first bend distance, round ostium shape, ostium surface area, and cactus morphology as stroke predictors.
- After adjusting for CHA2DS2-VASc score, the distance from LAA ostium to the first bend remained a significant independent risk factor for stroke.
Conclusions:
- The distance from the LAA ostium to the first bend is independently associated with stroke risk in AF patients.
- This anatomical parameter may aid in identifying AF patients at higher risk of ischemic stroke.
- Further validation in larger studies is needed to confirm these findings and their clinical utility.
Background:
The ASSAM study was designed to evaluate the association between left atrial appendage (LAA) morphology and stroke risk in patients with atrial fibrillation (AF).
Methods:
The study included 85 randomly chosen AF patients with acute ischemic stroke matched with 84 AF without stroke. All patients had left atrial (LA) computed tomography performed to analyze LAA anatomy.
Results:
Patients in the stroke group had a larger LAA volume (10.22 [7.83-13.62] vs. 9.33 cm3 [7.33-11.47], p = 0.046], greater distance from LAA ostium to the first LAA bend (9.25 ± 3.85 vs. 7.23 ± 2.95 mm, p = 0.0002), and more frequently had round LAA ostium shape (11.8 vs. 1.2%, p = 0.005). According to a multivariable model, significant predictors of ischemic stroke were distance from LAA ostium to the first LAA bend (OR 1.202 [1.065-1.356], p = 0.003), LAA ostium round shape of (OR 16.813 [1.857-152.231], p = 0.012), LAA ostium surface area (OR 0.612 [0.457-0.819], p = 0.009), and cactus LAA morphology (OR 2.739 [1.176-6.380], p = 0.016). After adjusting for CHA2DS2-VASc score, only the distance from LAA ostium to the first LAA bend remained a significant risk factor for stroke (OR 1.154 [1.014-1.314], p = 0.03).
Conclusions:
The distance from LAA ostium to the first bend of the LAA was independently associated with stroke risk in patients with AF. Whether this parameter may help improve identification of patients at risk of ischemic stroke, needs to be confirmed in larger studies.
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