Basu-Ray Indranill, Sudhakar Deepthi, Schwing Gregory, Monlezun Dominique, Zhang Lucy, Shah Sumit K, Pujara Deep, Ting Kevin, Rafeh Nidal Abi, Ali Gholam, Cassidy Mark, Ellenbogen Kenneth, Levine Glen, Lam Wilson, Mathuria Nilesh, Saeed Mohammad, Bunch Jared, Martin-Schild Sheryl, Gold Michael, Aryana Arash, Razavi Mehdi, Rasekh Abdi
Texas Heart Institute, Houston, TX, United States.
St. Francis Hospital, Memphis, TN, United States.
Front Cardiovasc Med. 2018 Oct 23;5:131. doi: 10.3389/fcvm.2018.00131. eCollection 2018.
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. 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. 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. 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.
缺血性中风带来了沉重的健康负担。然而，这些事件中有20%至40%的病因仍不明。左心耳形态可能影响血栓栓塞事件的发生。开展了一项回顾性横断面研究，以调查左心耳形态在房颤（AF）和心源性栓塞相关中风患者以及无房颤的隐源性中风患者中的作用。根据经食管超声心动图（TEE）检查结果，左心耳形态分为两组：（1）简单型（鸡翅型）与（2）复杂型（非鸡翅型）。除左心耳形态外，还收集了两组患者的左心房参数，包括开口直径、深度、排空速度和充盈速度。构建了数学计算模型，以研究鸡翅型和非鸡翅型形态模式下的流速，进一步评估左心耳功能。简单型和复杂型左心耳形态组之间的体积、大小、排空和充盈速度的TEE值相似。无合并房颤的隐源性中风患者的复杂型左心耳形态发生率显著更高。在计算模拟中，鸡翅型左心耳形态的流速（kg/s）高出四倍。复杂型左心耳形态可能是隐源性中风的一个独立促成因素。有必要开展进一步研究，以调查左心耳形态与血栓栓塞事件之间的机制。
