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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage angiography for stroke risk prediction in patients with atrial fibrillation
Lisheng Jiang1, Ziyong Hao1, Xiaoyi Xie2
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Insights
Impaired left atrial appendage (LAA) function, measured by LAA ejection fraction and contrast retention, is linked to stroke risk in atrial fibrillation (AF) patients. Angiographic assessment of LAA function improves stroke risk prediction beyond current scores.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Current stroke risk stratification in atrial fibrillation (AF) is inadequate.
- Accurate stroke risk assessment is crucial for patient management.
Purpose of the Study:
- To evaluate the association between left atrial appendage (LAA) mechanical function and stroke risk.
- To assess if LAA angiography can improve stroke risk prediction in AF patients.
Main Methods:
- Cross-sectional study involving 746 patients undergoing left atrial appendage occlusion (LAAO) procedure.
- Assessed LAA mechanical function using LAA ejection fraction (LAAEF) and contrast retention (CR) via angiography.
- Compared LAA function parameters between patients with and without a history of stroke.
Main Results:
- Patients with a stroke history had significantly lower LAAEF and higher rates of grade 3 CR.
- Contrast retention (CR) was independently associated with stroke in AF patients.
- CR demonstrated superior accuracy in identifying stroke compared to the CHA2DS2-VASc score, with combined CR and CHA2DS2-VASc showing the best performance.
Conclusions:
- Impaired LAA mechanical function (low LAAEF, high CR) is associated with stroke history in AF patients.
- LAA angiography for CR assessment enhances stroke risk stratification.
- This method offers improved prediction of stroke risk in AF patients.
Background:
The current risk stratification schemes for stroke in patients with atrial fibrillation (AF) are insufficient for an accurate assessment of stroke risk.
Aims:
This study evaluates the association between the mechanical function of the left atrial appendage (LAA), as assessed by angiography, and the risk of stroke.
Methods:
We conducted a cross-sectional study to assess the mechanical function of the LAA by measuring the left atrial appendage ejection fraction (LAAEF) and grading the contrast retention (CR) using angiography.
Results:
A total of 746 patients referred for a left atrial appendage occlusion (LAAO) procedure with (n=151; stroke group) or without (n=595; control group) a history of stroke were included in the analysis. LAAEF was significantly lower (14% [9-19] vs 20% [12-33]; p<0.001) and grade 3 CR was more common (66.9% vs 33.9%; p<0.001) in patients with a history of stroke. Multivariable analysis showed that CR was independently associated with stroke in patients with AF (grade 2 vs grade 1=7.29; 95% confidence interval [CI]: 2.84-21.65; p<0.001; grade 3 vs grade 1=16.45; 95% CI: 6.16-51.02; p<0.001). The receiver operating characteristics curve demonstrated that CR identified patients with stroke more accurately than the CHA2D-VASc score (C-statistic 0.712 vs 0.512; p<0.001), and the combination of CR and the CHA2DS2-VASc score provided the best performance (C-statistic 0.871 vs 0.829 [CHA2DS2-VASc score alone]; p=0.048) Conclusions: Impaired mechanical function of the LAA, indicated by a low LAAEF and CR, is associated with a history of stroke in patients with AF. Assessment of CR using LAA angiography helps improve the stratification scheme for stroke risk prediction.
