Sanatkhani Soroosh, Nedios Sotirios, Menon Prahlad G, Bollmann Andreas, Hindricks Gerhard, Shroff Sanjeev G
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.
Department of Electrophysiology, Massachusetts General Hospital, Boston, MA, United States.
Front Physiol. 2021 May 11;12:633135. doi: 10.3389/fphys.2021.633135. eCollection 2021.
Atrial fibrillation (AF) is the most common arrhythmia that leads to thrombus formation, mostly in the left atrial appendage (LAA). The current standard of stratifying stroke risk, based on the CHADS-VASc score, does not consider LAA morphology, and the clinically accepted LAA morphology-based classification is highly subjective. The aim of this study was to determine whether LAA blood-borne particle residence time distribution and the proposed quantitative index of LAA 3D geometry can add independent information to the CHADS-VASc score. Data were collected from 16 AF subjects. Subject-specific measurements included left atrial (LA) and LAA 3D geometry obtained by cardiac computed tomography, cardiac output, and heart rate. We quantified 3D LAA appearance in terms of a novel LAA (LAA-). We employed computational fluid dynamics analysis and a systems-based approach to quantify residence time distribution and associated calculated variable (LAA mean residence time, ) in each subject. The LAA- captured the subject-specific LAA 3D geometry in terms of a single number. LAA varied significantly within a given LAA morphology as defined by the current subjective method and it was not simply a reflection of LAA geometry/appearance. In addition, LAA- and LAA varied significantly for a given CHADS-VASc score, indicating that these two indices of stasis are not simply a reflection of the subjects' clinical status. We conclude that LAA- and LAA add independent information to the CHADS-VASc score about stasis risk and thereby can potentially enhance its ability to stratify stroke risk in AF patients.
心房颤动（AF）是导致血栓形成的最常见心律失常，血栓大多形成于左心耳（LAA）。基于CHADS-VASc评分的当前卒中风险分层标准未考虑左心耳形态，而临床上公认的基于左心耳形态的分类具有高度主观性。本研究的目的是确定左心耳血源性颗粒停留时间分布以及所提出的左心耳三维几何形状定量指标是否能为CHADS-VASc评分增加独立信息。从16名房颤患者中收集数据。针对个体的测量包括通过心脏计算机断层扫描获得的左心房（LA）和左心耳三维几何形状、心输出量和心率。我们根据一种新的左心耳指标（LAA-）对左心耳的三维外观进行量化。我们采用计算流体动力学分析和基于系统的方法来量化每个受试者的停留时间分布以及相关计算变量（左心耳平均停留时间，）。LAA-用一个数字反映了个体特异性的左心耳三维几何形状。在当前主观方法定义的给定左心耳形态内，LAA 差异显著，它并非仅仅是左心耳几何形状/外观的反映。此外，对于给定的CHADS-VASc评分，LAA-和LAA 差异显著，这表明这两个血流淤滞指标并非仅仅是受试者临床状态的反映。我们得出结论，LAA-和LAA 为CHADS-VASc评分增加了关于血流淤滞风险的独立信息，从而有可能增强其对房颤患者卒中风险分层的能力。
