Key result
Left atrial appendage morphologies with multiple lobes (cauliflower and cactus) were significantly associated with ESUS, whereas left atrial volume was similar between ESUS and non-AF patients.
Why the study?
Little was known about the role of left atrium parameters and left atrial appendage morphology in patients with embolic stroke of undetermined source.
Are left atrial volume and left atrial appendage morphology associated with embolic stroke of undetermined source compared to patients with and without atrial fibrillation?
Case-Control (n=60)
Are left atrial volume and left atrial appendage morphology associated with embolic stroke of undetermined source compared to patients with and without atrial fibrillation?
Complex left atrial appendage morphologies (cauliflower and cactus) are associated with embolic stroke of undetermined source, suggesting a potential structural mechanism for cardioembolism independent of left atrial enlargement.
LAA morphology may refine ESUS risk stratification beyond volume; hypothesis-generating and requires prospective validation.
Background Left atrium (LA) volume and function and certain left atrial appendage (LAA) morphologies are known to be strongly associated with the risk of thrombus formation and thromboembolism in patients with atrial fibrillation (AF). Little is known about the role of LA parameters and LAA morphology in patients with Embolic Stroke of Undetermined Source (ESUS). Purpose To assess LA volume and function and LAA morphologies in ESUS patients and the potential association with cardioembolic risk. Methods Twenty consecutive patients with ESUS who underwent contrast enhanced electrocardiogram-gated computed tomography (CT) as part of stroke etiology evaluation were matched by age and gender to patients with and without history of AF (twenty in each group) who had CT as part of standard evaluation before transcatheter aortic valve implantation. LA maximum (LAVmax) and minimum (LAVmin) volumes and function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF) were assessed, and three- dimensional structures of the LA and LAA were constructed using the volume-rendered post-processing technique. Results The mean age of patients was 75.9±8.61, 76.1±8.52, 77.8±7.72) in the ESUS, AF and non-AF groups, respectively, with 11 (55%) females in each group. Compared to patients with ESUS, patients with AF showed significantly greater LAVmax (100.59±31.59 ml vs.155.78±63.15 ml, respectively, p=0.001) and LAVmin (71.38±30.69 ml vs. 140.73±64.60 ml; respectively, p<0.001), while LAV max and LAVmin were similar, in patients with ESUS and non-AF. The distribution of LAA morphologies significantly differed between patients with ESUS and patients with AF and non-AF: 1 (5%) vs. 9 (45%) chicken-wing; 14 (70%) vs. 8 (40%) cauliflower; and 5 (25%) vs. 3 (15%) Cactus; respectively. Conclusion LA appendage morphology, but not LA volume, seems to be associated with ESUS. LAA morphologies with multiple lobes, cauliflower and cactus, seems to be associated with ESUS. Larger studies are needed to confirm these associations. Funding Acknowledgement Type of funding sources: None.
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Agmon et al. (2021) conducted a case-control in Embolic Stroke of Undetermined Source (ESUS) (n=60). Left atrial appendage morphology and left atrial volume vs. Patients with atrial fibrillation and patients without atrial fibrillation was evaluated on Left atrial volume and left atrial appendage morphology. Left atrial appendage morphologies with multiple lobes (cauliflower and cactus) were significantly associated with ESUS, whereas left atrial volume was similar between ESUS and non-AF patients.
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