Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores

Takehiro Kimura, Seiji Takatsuki, Kohei Inagawa, Yoshinori Katsumata, Takahiko Nishiyama, Nobuhiro Nishiyama, Kotaro Fukumoto, Yoshiyasu Aizawa, Yoko Tanimoto, Kojiro Tanimoto, Masahiro Jinzaki, Keiichi Fukuda

Research output: Contribution to journalArticle

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Abstract

BACKGROUND Strokes develop even in patients with low CHADS2 scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS2 scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS2 score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA2DS2-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA 2DS2-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS2 scores.

Original languageEnglish
Pages (from-to)921-925
Number of pages5
JournalHeart Rhythm
Volume10
Issue number6
DOIs
Publication statusPublished - 2013 Jun

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Atrial Appendage
Stroke
Brassica
Atrial Fibrillation
Anatomy
Odds Ratio
Tomography
Cactaceae
Confidence Intervals
Catheter Ablation
Brain Natriuretic Peptide
Left Ventricular Function
Chickens
Logistic Models
Regression Analysis

Keywords

  • Atrial fibrillation
  • CHADS score
  • Left atrial appendage
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. / Kimura, Takehiro; Takatsuki, Seiji; Inagawa, Kohei; Katsumata, Yoshinori; Nishiyama, Takahiko; Nishiyama, Nobuhiro; Fukumoto, Kotaro; Aizawa, Yoshiyasu; Tanimoto, Yoko; Tanimoto, Kojiro; Jinzaki, Masahiro; Fukuda, Keiichi.

In: Heart Rhythm, Vol. 10, No. 6, 06.2013, p. 921-925.

Research output: Contribution to journalArticle

Kimura, T, Takatsuki, S, Inagawa, K, Katsumata, Y, Nishiyama, T, Nishiyama, N, Fukumoto, K, Aizawa, Y, Tanimoto, Y, Tanimoto, K, Jinzaki, M & Fukuda, K 2013, 'Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores', Heart Rhythm, vol. 10, no. 6, pp. 921-925. https://doi.org/10.1016/j.hrthm.2013.01.036
Kimura, Takehiro ; Takatsuki, Seiji ; Inagawa, Kohei ; Katsumata, Yoshinori ; Nishiyama, Takahiko ; Nishiyama, Nobuhiro ; Fukumoto, Kotaro ; Aizawa, Yoshiyasu ; Tanimoto, Yoko ; Tanimoto, Kojiro ; Jinzaki, Masahiro ; Fukuda, Keiichi. / Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. In: Heart Rhythm. 2013 ; Vol. 10, No. 6. pp. 921-925.
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T1 - Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores

AU - Kimura, Takehiro

AU - Takatsuki, Seiji

AU - Inagawa, Kohei

AU - Katsumata, Yoshinori

AU - Nishiyama, Takahiko

AU - Nishiyama, Nobuhiro

AU - Fukumoto, Kotaro

AU - Aizawa, Yoshiyasu

AU - Tanimoto, Yoko

AU - Tanimoto, Kojiro

AU - Jinzaki, Masahiro

AU - Fukuda, Keiichi

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N2 - BACKGROUND Strokes develop even in patients with low CHADS2 scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS2 scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS2 score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA2DS2-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA 2DS2-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS2 scores.

AB - BACKGROUND Strokes develop even in patients with low CHADS2 scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS2 scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"- discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS2 score did not differ significantly between patients with stroke and controls (0.8 ± 0.8 vs 0.6 ± 0.7; P = .277). Eight (26.7%) patients with stroke had CHA2DS2-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA 2DS2-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS2 scores.

KW - Atrial fibrillation

KW - CHADS score

KW - Left atrial appendage

KW - Stroke

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