Complex Left Atrial Appendage Morphology Is an Independent Risk Factor for Cryptogenic Ischemic Stroke

Indranill Basu-Ray, Deepthi Sudhakar, Gregory Schwing, Dominique Monlezun, Lucy Zhang, Sumit K. Shah, Deep Pujara, Kevin Ting, Nidal Abi Rafeh, Gholam Ali, Mark Cassidy, Kenneth Ellenbogen, Glen Levine, Wilson Lam, Nilesh Mathuria, Mohammad Saeed, Jared Bunch, Sheryl Martin-Schild, Michael Gold, Arash AryanaMehdi Razavi, Abdi Rasekh

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Importance: Ischemic strokes pose a significant health burden. However, the etiology of between 20 and 40% of these events remains unknown. Left atrial appendage morphology may influence the occurrence of thromboembolic events. Design: A retrospective cross-sectional study was conducted to investigate the role of LAA morphology in patients with atrial fibrillation (AF) and cardioembolic-associated stroke and patients with cryptogenic stroke without atrial fibrillation. LAA morphology is classified into two groups: (1) simple (chicken-wing) vs. (2) complex (non-chicken wing) based on transesophageal echocardiography (TEE) findings. In addition to the LAA morphology, left atrial parameters, including orifice diameter, depth, emptying velocity, and filling velocity, were collected for both groups. Mathematical, computational models were constructed to investigate flow velocities in chicken-wing and non-chicken wing morphological patterns to assess LAA function further. Findings: TEE values for volume, size, emptying, and filling velocities were similar between simple and complex LAA morphology groups. Patients with cryptogenic stroke without coexisting AF were noted to have significantly higher rates of complex LAA morphology. Chicken-wing LAA morphology was associated with four-fold higher flow rate (kg/s) in computational simulations. Conclusions: Complex LAA morphology may be an independent contributing factor for cryptogenic strokes. Further studies are warranted to investigate the mechanism involved in LAA morphology and thromboembolic events.

Original languageEnglish (US)
Article number131
JournalFrontiers in Cardiovascular Medicine
Volume5
DOIs
StatePublished - Oct 23 2018

Keywords

  • atrial fibrillation
  • complex LAA morphology
  • cryptogenic stroke
  • left atrial appendage
  • left atrial appendage closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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