Abstract WMP72: High Risk Left Atrial Appendage Morphology (LAA-H) is Associated With Cardioembolic and Embolic Stroke of Unknown Source Subtypes

Autor: Scott Collins, Hooman Kamel, Mitchell S.V. Elkind, Shawna Cutting, Brian Mac Grory, Ashley Schomer, Luigi Di Biase, Michael K. Atalay, Shadi Yaghi, Ronald K. Akiki, Morgan Hemendinger, Karen L. Furie, Tracy Novack, Tina Burton, Ryan A McTaggart, Alexander E Merkler, Athena Poppas, Christopher Song, Andrew D Chang
Rok vydání: 2019
Předmět:
Zdroj: Stroke. 50
ISSN: 1524-4628
0039-2499
DOI: 10.1161/str.50.suppl_1.wmp72
Popis: Background: The left atrial appendage (LAA) is the main source of thrombus in atrial fibrillation (AF); biomarkers of LAA dysfunction are associated with ischemic stroke (IS) risk in patients with AF. We hypothesized that high risk LAA features [High risk morphology (LAA-H), LAA volume (LAAV), and LAA orifice surface area (LAAOSA)] would be more prevalent among patients with cardioembolic (CE) stroke and embolic stroke of undetermined source (ESUS) than among those with non-cardioembolic stroke (NCS). Methods: Consecutive patients with IS from a prospective comprehensive stroke center registry who previously underwent a clinically-indicated qualifying chest CT were included. Patients underwent inpatient diagnostic evaluation for ischemic stroke, and stroke subtype was determined based on ESUS criteria. LAA morphology [Low risk morphology was defined as two lobes with an acute angle between them or chicken wing morphology and LAA-H defined as all others], LAAOSA (measured in a plane parallel to the left atrium), and LAAV (measured using a volumetric analysis software) were determined using contrast enhanced thin-slice chest CT (≤2.5 mm thickness) by investigators blinded to stroke subtype. Results: Of 1234 patients with ischemic stroke, 329 (26.7%) patients had a qualifying chest CT performed (126 CE, 116 ESUS, and 87 NCS). The baseline characteristics of patients with and without chest CT were similar. When compared to NCS, LAA-H was more prevalent in ESUS (86.4% vs. 70.1%, p=0.018) and CE stroke (82.5% vs. 70.1%, p=0.042). The LAAOSA and volume did not significantly differ between the 3 groups (Table). Conclusion: LAA characteristics associated with cardioembolic stroke are also more prevalent in patients with ESUS. Larger studies are needed to confirm that LAA features are a risk factor for stroke among patients without AF, and whether anticoagulation is effective in patients with high-risk LAA features.
Databáze: OpenAIRE
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