Complex left appendage morphology is associated with Embolic Stroke of Undetermined Source

Area of Science:

• Cardiology
• Neurology
• Radiology

Background:

• Left atrial appendage (LAA) morphology variations are linked to embolic risk in atrial fibrillation (AF) patients.
• Limited data exist on the association between LAA morphology and Embolic Stroke of Undetermined Source (ESUS).

Purpose of the Study:

• To investigate the association between LAA morphology and ESUS.
• To compare LAA morphology in ESUS patients versus AF patients.
• To analyze LAA morphology in ESUS patients who later developed AF compared to those who did not.

Main Methods:

• Cardiac computed tomography (CCT) scans were used to categorize LAA morphology (chicken wing, cactus, windsock, cauliflower).
• Complex LAA morphology was defined by the presence of large secondary lobes.
• LAA morphologies were compared between ESUS (n=134) and AF (n=120) groups, and within ESUS patients based on subsequent AF diagnosis.

Main Results:

• ESUS patients showed a higher prevalence of cauliflower morphology than AF patients (52% vs 34%, p=0.01).
• ESUS patients had a significantly higher prevalence of large secondary lobes compared to AF patients (50% vs 29%, p=0.001).
• Among ESUS patients, large secondary lobes were more prevalent in those without a subsequent AF diagnosis.

Conclusions:

• ESUS patients exhibit a high prevalence of complex LAA morphology.
• Complex LAA morphology may be associated with an elevated risk of thrombus formation, independent of AF.
• Further research is warranted to explore the clinical implications of complex LAA morphology in ESUS.