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Sex and Racial Differences in Left Atrial Appendage Morphology
Ahmed Wahaj1, Madeline E Mauri2, Matthew J Bocchese2
1Rawalpindi Medical University Rawalpindi Pakistan.
Insights
Black patients with atrial fibrillation have a higher prevalence of the cauliflower left atrial appendage morphology, a high-stroke risk factor. This finding suggests potential racial disparities in stroke risk associated with LAA anatomy.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Atrial fibrillation (AF) patients who are Black or female experience higher stroke rates.
- Specific left atrial appendage (LAA) morphologies are linked to increased stroke risk.
- Racial and sexual variations in LAA anatomy and their association with stroke risk are largely unexplored.
Purpose of the Study:
- To investigate potential associations between patient race and sex with LAA morphology.
- To explore if LAA anatomical differences contribute to stroke risk disparities in Black and female AF patients.
Main Methods:
- Computed tomography (CT) scans of 211 patients were analyzed for LAA morphology.
- LAA morphologies were categorized using a scoring system based on thrombus risk (chicken wing, windsock, cactus, cauliflower).
- Statistical analyses, including Wilcoxon rank-sum and Fisher's exact tests, were used to compare morphology prevalence and scores across racial and sex groups. Logistic regression identified associations between race/sex and high-risk LAA morphologies.
Main Results:
- No significant differences in projected stroke risk scores were observed between Black and non-Black patients, or between men and women.
- The 'cauliflower' LAA morphology, associated with the highest stroke risk, was significantly more prevalent in Black patients compared to non-Black patients (adjusted OR, 4.8; P=0.035).
- While 'cauliflower' morphology was more frequent in women, this finding did not reach statistical significance (P=0.063).
Conclusions:
- The 'cauliflower' LAA morphology, a high-risk factor for stroke, shows a higher prevalence in Black patients.
- The observed difference in LAA morphology between sexes did not achieve statistical significance.
- These preliminary findings suggest potential racial disparities in stroke risk due to LAA anatomy, warranting further investigation despite the study's limitations in statistical power.
Background:
Black and female patients with atrial fibrillation have more strokes. Certain left atrial appendage (LAA) morphologies impose a higher stroke risk. Whether anatomic differences in LAA morphology are associated with race or sex remains unexplored.
Methods:
We identified consecutive patients with computed tomography for LAA morphology and categorized each patient by self-reported race (Black versus non-Black) and sex. Each LAA morphology was assigned a score based on published relative LAA thrombus risk (lowest to highest: "chicken wing," "windsock" and "cactus," "cauliflower"). Scores and prevalence were compared across races and sexes using a Wilcoxon rank-sum test and Fisher's exact test, respectively. Logistic regression was performed to find the association of race (adjusting for sex) and sex with higher risk LAA morphologies.
Results:
Among 211 patients (27% Black, n=58; 47% female, n=100), there was no difference in the projected hypothetical stroke risk across race or sex (median for Black versus non-Black patients: 1 [interquartile range, 1-4] versus 1 [interquartile range, 1-1], P=0.11; median for women versus men: 1 [interquartile range, 1-4] versus 1 [interquartile range, 1-4], P=0.62). The highest risk LAA morphology, cauliflower, had greater odds of being present in Black versus non-Black patients (unadjusted odds ratio [OR], 6.0 [1.4-25.1], P=0.049; adjusted OR, 4.8 [1.1-20.9], P=0.035). Although cauliflower LAA morphology was more prevalent in women (n=7 [9%] versus n=2 [2%] in men; P=0.063), this difference nor odds of cauliflower LAA morphology being present in women were statistically significant.
Conclusions:
The highest risk LAA morphology, cauliflower, demonstrated greater odds of being present in Black patients versus non-Black patients. The difference in women versus men did not reach statistical significance. Although the study was underpowered to make the findings declarative, these results are provocative regarding the differential stroke risk across races and sexes.
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