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Cardiogenic Stroke Despite Low CHA 2 DS 2 ‐VASc Score: Assessing Stroke risk by Left Atrial Appendage Anatomy (ASK LAA)
Author(s) -
NEDIOS SOTIRIOS,
KOUTALAS EMMANUEL,
KORNEJ JELENA,
ROLF SASCHA,
ARYA ARASH,
SOMMER PHILIPP,
HUSSER DANIELA,
HINDRICKS GERHARD,
BOLLMANN ANDREAS
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12749
Subject(s) - medicine , cardiology , atrial fibrillation , stroke (engine) , takeoff , mechanical engineering , materials science , engineering , composite material
Assessing Stroke risK by LAA Anatomy (ASK LAA) Introduction In patients with atrial fibrillation (AF), LAA morphology has been suggested to modify thromboembolic event (TE) risk. We tested the hypothesis that TE in low‐risk patients is associated with LAA characteristics. Methods Of 2,069 patients who underwent AF ablation, 25 (1.2%) had a prior TE and a low CHA 2 DS 2 ‐VASc score (≤1). Those patients were matched for the CHA 2 DS 2 ‐VASc criteria with 75 eventfree patients and CT data were compared. LAA measurements, morphology (Cactus, Chicken‐Wing, Windsock, Cauliflower), and takeoff of the superior and inferior edge in relation (higher or lower) to the respective takeoff of the adjacent pulmonary vein (PV) were determined. LAA flow in relation to heart rate was also compared. Results Univariate analysis showed that TE patients had a higher incidence of superior LAA takeoff (i.e., higher than the left superior PV; 28% vs. 4%, P = 0.002) and a higher incidence of hyperlipidemia (40% vs. 17%, P = 0.028), while LAA morphologies, inferior takeoff, and other LAA characteristics were similar between groups. Logistic regression revealed that a superior LAA takeoff (OR: 9.1, 95% CI: 2.1–38.6, P = 0.003) was the only independent predictor of TE. There was a negative correlation between heart rate and LAA flow (r = –0.2 cm/s pro bpm, P = 0.048), that was even more pronounced for the superior LAA takeoff (r = –0.67 cm/s pro bpm, P = 0.035). Conclusion A higher LAA takeoff is associated with a tachycardia‐mediated thrombogenic flow and an increased thromboembolic risk. These findings may have implications for anticoagulation management of AF patients with low CHA 2 DS 2 ‐VASc scores and higher LAA takeoff.