Why the study?
The study aimed to correlate left atrial appendage morphology with thrombus formation in patients with severe aortic valve stenosis and atrial fibrillation.
Does non-chicken-wing LAA morphology increase the risk of LAA thrombus compared to chicken-wing morphology in patients with atrial fibrillation and severe aortic valve stenosis?
Does non-chicken-wing LAA morphology increase the risk of LAA thrombus compared to chicken-wing morphology in patients with atrial fibrillation and severe aortic valve stenosis?
Non-chicken-wing LAA morphology is associated with a higher rate of LAA thrombus, but in the presence of a thrombus, chicken-wing morphology carries a higher risk of neuro-embolic events in TAVI patients with atrial fibrillation.
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Non-chicken-wing LAA morphology may support thrombus screening in AF-TAVI patients; leaves open morphology-specific embolic risk beyond thrombus presence.
PURPOSE: We aimed to correlate left atrial appendage (LAA) morphology with thrombus formation in patients with severe aortic valve stenosis and atrial fibrillation. METHODS: 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. RESULTS: 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%). CONCLUSION: 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.
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Abanador-Kamper et al. (2023) studied this question.
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