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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The clinical association of left atrial appendage thrombus on CTA with functional outcome
Joel Winders1, Angelo Di Bartolo2, Jamin Kim1
1Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Insights
Left atrial appendage (LAA) thrombus in patients with acute stroke or TIA is linked to worse outcomes. Computed tomography angiography (CTA) can identify LAA thrombus, a predictor of poorer 3-month functional status.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Left atrial appendage (LAA) thrombus is a known complication of atrial fibrillation (AF) and a potential indicator of atrial cardiomyopathy.
- The presence of LAA thrombus in patients experiencing acute ischemic stroke or transient ischemic attack (TIA) requires further investigation regarding its prognostic implications.
Purpose of the Study:
- To determine the association between computed tomography angiography (CTA)-identified LAA thrombus and 3-month outcomes in patients presenting with acute ischemic stroke or TIA.
- To evaluate LAA thrombus as an independent predictor of functional outcome after acute cerebrovascular events.
Main Methods:
- A dual-centre, retrospective cohort study was conducted, including consecutive patients who presented with acute ischemic stroke or TIA and underwent acute stroke imaging.
- Data on CTA-LAA thrombus and 3-month modified Rankin Scale (mRS) scores were analyzed.
- Multivariable logistic regression models were employed to adjust for known predictors of outcome.
Main Results:
- Of 1435 patients, 58 (4.0%) had CTA-LAA thrombus. These patients were older, more frequently female, and had higher rates of AF, heart failure, and medium or large vessel occlusion (MLVO).
- Patients with CTA-LAA thrombus exhibited significantly higher 3-month mortality (28% vs 11%).
- After adjusting for confounding factors, LAA thrombus was independently associated with an increased 3-month mRS score (OR: 2.02, 95% CI: 1.20-3.40).
Conclusions:
- CTA-identified LAA thrombus during acute stroke imaging is a significant predictor of worse functional outcome at 3 months in patients with ischemic stroke or TIA.
- This finding highlights the importance of assessing LAA status in acute stroke patients to identify individuals at higher risk for adverse outcomes.
Background:
Left atrial appendage (LAA) thrombus is associated with atrial fibrillation (AF) and can be a marker of atrial cardiomyopathy. We determined the association between computed tomography angiography (CTA) identified LAA thrombus in patients presenting with acute ischaemic stroke or transient ischaemic attack (TIA), and 3-month outcome.
Methods:
We undertook a dual-centre, retrospective cohort study from New Zealand and Australia. All consecutive patients presenting with acute ischaemic stroke or TIA during the inclusion period who underwent acute stroke imaging were included. We analysed the association with CTA-LAA thrombus and 3-month outcome on modified Rankin Scale using multivariable logistic regression models adjusted for known predictors of outcome.
Results:
Of the 1435 patients included, 1304 (90.9%) had acute ischaemic stroke and 131 (9.1%) had TIA. 582 (41%) had confirmed intracranial medium or large vessel occlusion (MLVO), and 565 (40%) received reperfusion therapies. CTA-LAA thrombus was identified in 58 (4.0%) patients, and these patients were older (median age 85 (IQR 75-88) vs 73 (63-81), p < 0.01), more likely to be female (62% vs 40%, p < 0.01), had higher rates of AF (79% vs 29%, p < 0.01), heart failure (29% vs 9%, p < 0.01), MLVO (53% vs 40%, p = 0.05), and mortality at 3-months (28% vs 11%, p < 0.01). Adjusting for known predictors of poor outcome, LAA thrombus was independently associated with increased 3-month mRS score (OR: 2.02, 95% CI: 1.20-3.40, p < 0.01).
Conclusions:
CTA-LAA thrombus detected during the acute stroke imaging protocol in patients with ischemic stroke or TIA is a predictor of worse outcome.
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