Key result
Patient-specific computational fluid dynamics simulations demonstrated that patients with a history of left atrial appendage thrombus or transient ischemic attack had markedly higher blood residence time and lower kinetic energy in the appendage.
Why the study?
Personalized stroke risk stratification in AF patients is needed to better balance preventive anticoagulation against bleeding risk.
Does patient-specific analysis by computational fluid dynamics (CFD) predict the risk of LAA thrombosis in patients with atrial fibrillation?
Observational (n=6)
Yes
Does patient-specific analysis by computational fluid dynamics (CFD) predict the risk of LAA thrombosis in patients with atrial fibrillation?
Patient-specific computational fluid dynamics simulations of the left atrium can identify hemodynamic alterations, such as increased residence time and decreased kinetic energy, associated with LAA thrombosis risk.
LAA flow metrics may aid future risk stratification; hypothesis-generating and requires prospective validation before clinical use.
Atrial fibrillation (AF) alters left atrial (LA) hemodynamics, which can lead to thrombosis in the left atrial appendage (LAA), systemic embolism and stroke. A personalized risk-stratification of AF patients for stroke would permit improved balancing of preventive anticoagulation therapies against bleeding risk. We investigated how LA anatomy and function impact LA and LAA hemodynamics, and explored whether patient-specific analysis by computational fluid dynamics (CFD) can predict the risk of LAA thrombosis. We analyzed 4D-CT acquisitions of LA wall motion with an in-house immersed-boundary CFD solver. We considered six patients with diverse atrial function, three without a LAA thrombus (LAAT/TIA-neg), and three with either a LAA thrombus (removed digitally before running the simulations) or a history of transient ischemic attacks (LAAT/TIA-pos). We found that blood inside the left atrial appendage of LAAT/TIA-pos patients had marked alterations in residence time and kinetic energy when compared with LAAT/TIA-neg patients. In addition, we showed how the LA conduit, reservoir and booster functions distinctly affect LA and LAA hemodynamics. While the flow dynamics of fixed-wall and moving-wall simulations differ significantly, fixed-wall simulations risk-stratified our small cohort for LAA thrombosis only slightly worse than moving-wall simulations.
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García‐Villalba et al. (2020) conducted an observational in Atrial fibrillation and LAA thrombosis (n=6). History of LAA thrombus or TIA (LAAT/TIA-pos) vs. No LAA thrombus or TIA (LAAT/TIA-neg) was evaluated on Blood residence time and kinetic energy in the LAA. Patient-specific computational fluid dynamics simulations demonstrated that patients with a history of left atrial appendage thrombus or transient ischemic attack had markedly higher blood residence time and lower kinetic energy in the appendage.
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