Beyond CHA₂DS₂-VASc: Hemodynamic and Morphologic Discriminants for Thrombus Formation and Stroke in Atrial Fibrillation Patients

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=40). Intervention: Hemodynamic and morphometric parameters (LA volume, LAA orifice size, LAA depth). Primary outcome: Thrombus presence or stroke history.

Q: What does this research mean for the field?

Larger left atrial volume, left atrial appendage orifice size, and left atrial appendage depth strongly correlate with thrombus presence or stroke history in atrial fibrillation patients, providing risk stratification that complements the CHA2DS2-VASc score. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Henrik A. Kjeldsberg; Josquin Harrison; Maxime Sermesant; Renate B. Schnabel; Joakim Sundnes; Kristian Valen‐Sendstad

doi:10.1007/s10439-026-04039-3

March 6, 2026Annals of Biomedical Engineering

Beyond CHA₂DS₂-VASc: Hemodynamic and Morphologic Discriminants for Thrombus Formation and Stroke in Atrial Fibrillation Patients

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Key result

Larger left atrial and LAA dimensions correlate with thrombus and stroke in AF, complementing CHA2DS2-VASc.

n=40

Why the study?

Stroke is a leading cause of death worldwide with AF contributing up to a third of ischemic strokes, warranting evaluation of discriminants beyond current clinical risk scores.

Key Points

To evaluate whether computational fluid dynamics and morphometric parameters derived from patient-specific left atrial models can identify risk factors for thrombus formation and stroke in atrial fibrillation.
Reconstructed N=40 patient-specific left atrium (LA) models from computed tomography incorporating atrial fibrillation wall motion.
Conducted high-fidelity computational fluid dynamics simulations under pathological conditions to quantify hemodynamic and morphometric indices.
Performed univariate and multivariate linear and logistic regression analyses to correlate computed metrics with thrombus presence or stroke history.
Univariate logistic regression revealed significant correlations with thrombus presence or stroke history for LA volume (Pseudo R²=0.569, p=0.001), LAA orifice size (Pseudo R²=0.555, p=0.003), and LAA depth (Pseudo R²=0.470, p=0.009).
Left atrial appendage hemodynamic metrics associated significantly with thrombus or stroke, including relative residence time (Pseudo R²=0.803, p=0.040), endothelial cell activation potential (Pseudo R²=0.465, p=0.014), and wall shear stress (Pseudo R²=0.343, p=0.024).
Blood residence time in the left atrium demonstrated significant associations in both univariate (Pseudo R²=0.607, p=0.008) and multivariate logistic regression (Pseudo R²=0.765, p=0.010).

Study Design

Type

Observational (n=40)

Structured PICO

P

Population

40 patient-specific left atrial models reconstructed from computed tomography of patients with atrial fibrillation.

E

Exposure

High-fidelity computational fluid dynamics (CFD) simulations and morphometric analysis

O

Outcome

Correlation of hemodynamic and morphometric parameters with thrombus presence or stroke historysurrogate

CFD-based hemodynamic and morphometric parameters, such as LA volume and LAA orifice size, correlate strongly with thrombus presence or stroke history in AF patients, potentially complementing clinical risk scores.

Implication

May complement CHA2DS2-VASc for AF stroke risk stratification; extends current scores but leaves open adoption pending validation.

Discussion

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Cite This Study

Kjeldsberg et al. (2026) conducted an observational in Atrial fibrillation (n=40). Hemodynamic and morphometric parameters (LA volume, LAA orifice size, LAA depth) was evaluated on Thrombus presence or stroke history. Left atrial volume, left atrial appendage orifice size, and depth correlated strongly with thrombus presence or stroke history in computational models of patients with atrial fibrillation.

synapsesocial.com/papers/69af23813eac3accde8a176a https://doi.org/10.1007/s10439-026-04039-3