Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland.
Department of Radiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
Int J Cardiol. 2021 May 1;330:65-72. doi: 10.1016/j.ijcard.2021.01.001. Epub 2021 Jan 29.
The ASSAM study was designed to evaluate the association between left atrial appendage (LAA) morphology and stroke risk in patients with atrial fibrillation (AF).
The study included 85 randomly chosen AF patients with acute ischemic stroke matched with 84 AF without stroke. All patients had left atrial (LA) computed tomography performed to analyze LAA anatomy.
Patients in the stroke group had a larger LAA volume (10.22 [7.83-13.62] vs. 9.33 cm [7.33-11.47], p = 0.046], greater distance from LAA ostium to the first LAA bend (9.25 ± 3.85 vs. 7.23 ± 2.95 mm, p = 0.0002), and more frequently had round LAA ostium shape (11.8 vs. 1.2%, p = 0.005). According to a multivariable model, significant predictors of ischemic stroke were distance from LAA ostium to the first LAA bend (OR 1.202 [1.065-1.356], p = 0.003), LAA ostium round shape of (OR 16.813 [1.857-152.231], p = 0.012), LAA ostium surface area (OR 0.612 [0.457-0.819], p = 0.009), and cactus LAA morphology (OR 2.739 [1.176-6.380], p = 0.016). After adjusting for CHADS-VASc score, only the distance from LAA ostium to the first LAA bend remained a significant risk factor for stroke (OR 1.154 [1.014-1.314], p = 0.03).
The distance from LAA ostium to the first bend of the LAA was independently associated with stroke risk in patients with AF. Whether this parameter may help improve identification of patients at risk of ischemic stroke, needs to be confirmed in larger studies.
ASSAM 研究旨在评估左心耳（LAA）形态与房颤（AF）患者中风风险之间的关系。
该研究纳入了 85 名随机选择的急性缺血性中风 AF 患者，并与 84 名无中风的 AF 患者相匹配。所有患者均进行了左心房（LA）计算机断层扫描以分析 LAA 解剖结构。
中风组患者的 LAA 体积较大（10.22 [7.83-13.62] 比 9.33 cm [7.33-11.47]，p=0.046），LAA 开口至第一个 LAA 弯曲处的距离更大（9.25 ± 3.85 比 7.23 ± 2.95 mm，p=0.0002），并且更常出现圆形 LAA 开口形状（11.8% 比 1.2%，p=0.005）。根据多变量模型，缺血性中风的显著预测因子是 LAA 开口至第一个 LAA 弯曲处的距离（OR 1.202 [1.065-1.356]，p=0.003），LAA 开口的圆形形状（OR 16.813 [1.857-152.231]，p=0.012），LAA 开口表面积（OR 0.612 [0.457-0.819]，p=0.009）和仙人掌状 LAA 形态（OR 2.739 [1.176-6.380]，p=0.016）。在调整 CHADS-VASc 评分后，只有 LAA 开口至第一个 LAA 弯曲处的距离仍然是中风的显著危险因素（OR 1.154 [1.014-1.314]，p=0.03）。
LAA 开口至 LAA 第一个弯曲处的距离与 AF 患者的中风风险独立相关。该参数是否有助于更好地识别缺血性中风风险患者，需要在更大的研究中进一步证实。
