Department of Medicine/Cardiology.
Heart Rhythm. 2013 Dec;10(12):1843-9. doi: 10.1016/j.hrthm.2013.09.065. Epub 2013 Sep 25.
Atrial fibrillation (AF) is an important cause of stroke. Given the morbidity and mortality associated with stroke, the risk stratification of patients based on left atrial appendage (LAA) characteristics is of great interest.
To explore the association between LAA morphology and LAA characteristics including the extent of trabeculations, orifice diameter, and length with prevalent stroke in a large cohort of patients with drug refractory AF who underwent AF ablation to develop mechanistic insight regarding the risk of stroke.
An institutional cohort of 1063 patients referred for AF ablation from 2003 to 2012 was reviewed to identify patients that underwent preprocedural cardiac computed tomography (CT). LAA morphology was characterized as chicken wing, cactus, windsock, or cauliflower by using previously reported methodology. Left atrial size and LAA trabeculations, morphology, orifice diameter, and length were compared between patients with prevalent stroke and patients without prevalent stroke.
Of 678 patients with CT images, 65 (10%) had prior stroke or transient ischemic attack. In univariate analyses, prevalent heart failure (7.7% in cases vs 2.8% in controls; P = .033), smaller LAA orifice (2.26 ± 0.52 cm vs 2.78 ± 0.71 cm ; P < .001), shorter LAA length (5.06 ± 1.17 cm vs 5.61 ± 1.17 cm; P < .001), and extensive LAA trabeculations (27.7% vs 14.4%; P = .019) were associated with stroke. LAA morphologies were unassociated with stroke risk. In multivariable analysis, smaller LAA orifice diameter and extensive LAA trabeculations remained independently associated with thromboembolic events.
The extent of LAA trabeculations and smaller LAA orifice diameter are associated with prevalent stroke and may mediate the previously described association of cauliflower LAA morphology with stroke.
心房颤动（AF）是中风的一个重要原因。鉴于中风相关的发病率和死亡率，基于左心耳（LAA）特征对患者进行风险分层具有重要意义。
探讨大量药物难治性 AF 患者左心耳形态与左心耳特征（包括小梁数量、开口直径和长度）与既往中风之间的关系，以深入了解中风风险的机制。
回顾性分析 2003 年至 2012 年期间因 AF 消融而接受 AF 消融的 1063 例患者的机构队列，以确定接受术前心脏计算机断层扫描（CT）的患者。使用先前报道的方法，将左心耳形态描述为鸡翅型、仙人掌型、风袋型或菜花型。比较有既往中风和无既往中风患者的左心房大小和左心耳小梁、形态、开口直径和长度。
在 678 例有 CT 图像的患者中，有 65 例（10%）有既往中风或短暂性脑缺血发作。在单因素分析中，既往心力衰竭（病例中 7.7%，对照组中 2.8%；P =.033）、较小的左心耳开口（2.26 ± 0.52cm 比 2.78 ± 0.71cm；P <.001）、较短的左心耳长度（5.06 ± 1.17cm 比 5.61 ± 1.17cm；P <.001）和广泛的左心耳小梁（27.7%比 14.4%；P =.019）与中风有关。左心耳形态与中风风险无关。在多变量分析中，较小的左心耳开口直径和广泛的左心耳小梁仍然与血栓栓塞事件独立相关。
左心耳小梁的范围和较小的左心耳开口直径与既往中风有关，可能介导先前描述的菜花型左心耳形态与中风之间的关系。
