Cardiology & Heart Center, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Witten, Germany.
Gynaecology, Marien Hospital Witten, University Witten/Herdecke, Witten, Germany.
Eur J Med Res. 2023 Feb 20;28(1):88. doi: 10.1186/s40001-023-01057-y.
We aimed to correlate left atrial appendage (LAA) morphology with thrombus formation in patients with severe aortic valve stenosis and atrial fibrillation.
We analyzed LAA morphology and the prevalence of a thrombus in 231 patients with atrial fibrillation and severe aortic valve stenosis that were referred for pre-interventional CT scan before trans-catheter aortic valve implantation (TAVI) between 2016 and 2018. In addition, we documented neuro-embolic events depending on the presence of LAA thrombus within a follow-up of 18 months.
The overall distribution of different LAA morphologies was chicken-wing 25.5%, windsock 51.5%, cactus 15.6% and cauliflower 7.4%. Compared to chicken-wing morphology, patients with non-chicken-wing morphology showed a significantly higher thrombus rate (OR: 2.48, 95%; CI 1.05 to 5.86, p = 0.043). Within the 50 patients with a LAA thrombus, we observed chicken-wing (14.0%), windsock (62.0%), cactus (16.0%) and cauliflower (8.0%) configuration. In patients with LAA thrombus those with chicken-wing configuration have a higher risk (42.9%) to develop neuro-embolic events compared to non-chicken-wing configuration (20.9%).
We found a lower LAA thrombus rate in patients with chicken-wing morphology compared to patients with non-chicken-wing configuration. However, in the presence of thrombus, those patients with chicken-wing morphology showed a doubled risk for neuro-embolic events compared to patients with non-chicken-wing morphology. These results must be confirmed in larger trials but underline the importance of LAA evaluation in thoracic CT scans and could have an impact on the anticoagulation management.
我们旨在探讨左心耳（LAA）形态与严重主动脉瓣狭窄合并心房颤动患者血栓形成的相关性。
我们分析了 2016 年至 2018 年间 231 例因经导管主动脉瓣植入术（TAVI）前接受 CT 扫描的严重主动脉瓣狭窄合并心房颤动患者的 LAA 形态和血栓发生率。此外，我们还记录了 18 个月随访期间 LAA 血栓形成患者的神经栓塞事件。
不同 LAA 形态的总体分布为鸡翅型 25.5%、风帆型 51.5%、仙人掌型 15.6%和菜花型 7.4%。与鸡翅形态相比，非鸡翅形态患者的血栓发生率明显更高（OR：2.48，95%CI：1.05 至 5.86，p=0.043）。在 50 例 LAA 血栓患者中，我们观察到鸡翅型（14.0%）、风帆型（62.0%）、仙人掌型（16.0%）和菜花型（8.0%）。在 LAA 血栓患者中，鸡翅型患者发生神经栓塞事件的风险（42.9%）高于非鸡翅型患者（20.9%）。
与非鸡翅形态患者相比，我们发现鸡翅形态患者的 LAA 血栓发生率较低。然而，在存在血栓的情况下，鸡翅形态患者发生神经栓塞事件的风险是无血栓患者的两倍。这些结果需要在更大的试验中得到证实，但强调了胸部 CT 扫描中 LAA 评估的重要性，并可能对抗凝管理产生影响。
