Wang Lingfeng, Wang Zidun, Fang Runxin, Li Zhi-Yong
School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Front Cardiovasc Med. 2022 Apr 29;9:842364. doi: 10.3389/fcvm.2022.842364. eCollection 2022.
It is well known that the thrombus triggering stroke in patients with atrial fibrillation (AF) mainly comes from the left atrial appendage (LAA). This study aims to characterize the morphological and hemodynamic parameters and evaluate their differences between AF patients with and without a stroke history.
Cardiac CT images were obtained from AF patients with ( = 10) and without a history of stroke ( = 10). 3D models of the left atrium (LA) were reconstructed by processing the CT image, and the LA/LAA morphological parameters were measured. Computational fluid dynamics (CFD) simulations were performed to calculate the hemodynamic parameters in LA. The species-transport model and discrete phase model (DPM) were applied to analyze blood residual ratio and particle residual ratio, two qualitative parameters for thrombus formation and flow-out potential, respectively.
There were significant differences in LAA actual depth ( = 0.002), and direct length ( = 0.049) between the non-stroke and stroke groups. Significant differences were also found in certain hemodynamic parameters. The blood residual ratio in LAA was significantly smaller in the stroke group than in the non-stroke group ( < 0.05). Moreover, the particle residual ratio within LAA was significantly smaller in the stroke groups than in the non-stroke group ( < 0.05).
There are significant differences in both morphological and hemodynamic parameters between AF patients with and without a stroke history. A high blood residual ratio in LAA confirms that thrombus is more likely to form in AF patients. A significantly smaller particle residual ratio in the stroke group may suggest the thrombus formed with LAA is more likely to flow out of LAA, leading to a higher risk of stroke. The proposed morphological and hemodynamic parameters may be additional risk factors that can be used to better risk stratify AF patients.
众所周知，心房颤动（AF）患者引发中风的血栓主要来自左心耳（LAA）。本研究旨在描述形态学和血流动力学参数，并评估有中风病史和无中风病史的AF患者之间的差异。
从有中风病史（n = 10）和无中风病史（n = 10）的AF患者中获取心脏CT图像。通过处理CT图像重建左心房（LA）的三维模型，并测量LA/LAA形态学参数。进行计算流体动力学（CFD）模拟以计算LA中的血流动力学参数。应用物种输运模型和离散相模型（DPM）分别分析血液残留率和颗粒残留率，这两个定性参数分别用于评估血栓形成和流出可能性。
非中风组和中风组之间的LAA实际深度（P = 0.002）和直接长度（P = 0.049）存在显著差异。在某些血流动力学参数方面也发现了显著差异。中风组LAA中的血液残留率明显低于非中风组（P < 0.05）。此外，中风组LAA内的颗粒残留率明显低于非中风组（P < 0.05）。
有中风病史和无中风病史的AF患者在形态学和血流动力学参数方面均存在显著差异。LAA中较高的血液残留率证实AF患者更容易形成血栓。中风组中明显较小的颗粒残留率可能表明由LAA形成的血栓更有可能流出LAA，从而导致中风风险更高。所提出的形态学和血流动力学参数可能是可用于更好地对AF患者进行风险分层的额外风险因素。
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