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Left Atrial Appendage Pseudothrombus Is Associated With Stroke History in Patients With Atrial Fibrillation

Edward Nicol1,2,3, Nabeela Karim4, Tom Semple2

  • 1Cardiology Department Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust London UK.

Journal of the American Heart Association
|June 6, 2024
PubMed

Insights

Left atrial appendage pseudothrombus (LAAPT) is common in nonvalvular atrial fibrillation (NVAF) and significantly increases stroke risk. This finding on cardiovascular computed tomography (CCT) may help stratify stroke risk beyond the CHA2DS2-VASc score.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • The left atrial appendage (LAA) is a primary source of thrombus in nonvalvular atrial fibrillation (NVAF).
  • Left atrial appendage pseudothrombus (LAAPT) is a filling defect on initial cardiovascular computed tomography (CCT) scans, with its clinical significance in NVAF patients being unclear.
  • This study investigates the relationship between LAAPT and stroke history in NVAF patients.

Purpose of the Study:

  • To determine the association between LAAPT identified on CCT and the history of stroke in patients with NVAF.
  • To explore whether LAAPT can serve as an independent risk factor for stroke in this population.

Main Methods:

  • A cohort of 213 consecutive NVAF patients undergoing CCT were assessed for LAAPT.
  • Analysis included correlation of LA and LAA dimensions and morphology with clinical demographics and stroke history.
  • Multivariable analysis was performed to assess the independent association of LAAPT with stroke, adjusting for the CHA2DS2-VASc score.

Main Results:

  • LAAPT was identified in 27.7% of the 213 NVAF patients.
  • Specific LAA characteristics, including larger ostium area, increased volume, and lower tortuosity, were associated with LAAPT.
  • LAAPT on CCT was independently associated with a history of stroke (OR, 3.20) and remained significant after adjusting for the CHA2DS2-VASc score.

Conclusions:

  • LAAPT is a prevalent finding on CCT in NVAF patients.
  • LAAPT demonstrates a strong positive association with stroke prevalence, independent of the CHA2DS2-VASc score.
  • LAAPT identified via CCT may offer additional value in stratifying stroke risk for NVAF patients.
Abstract

Keywords:
atrial fibrillationcomputed tomographyleft atrial appendagepseudothrombusstroke

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