The morphology and function of left atrial appendage in the risk assessment of stroke in patients with non-valvular atrial fibrillation

doi:10.16150/j.1671-2870.2020.02.010

Abstract

Abstract:

Objective: To explore anatomic structure and function of left atrial appendage (LAA) in the risk assessment of cardiogenic stroke in patients with atrial fibrillation (AF). Methods: A total of 223 patients with non-valvular atrial fibrillation (NVAF), including 70 with and 153 without episodes of cardiogenic stroke, were enrolled in the study. The transthoracic and transesophageal echocardiography were retrieved and analyzed along with clinical data. Results: Between subjects with and without episodes of stroke, there were significant differences in demographic and laboratory parameters, including age, prevalence of hypertension or diabetes, glomerular filtration rate, atrial size of both sides, opening inner diameter of each angle of LAA, depth of the LAA, ratio of the depth/opening inner diameter, spontaneous echo contrast (SEC) in LAA and the blood flow (P<0.05). Patients with cactus- or cauliflower-shaped LAA had a higher incidence of stoke than those with wing- or wind vane-shaped LAA. Multivariable logistic regression analysis showed that higher sum of opening inner diameters and higher blood flow velocity in LAA were protective factors against stroke, and the higher sum of depths in LAA was an independent risk factor for stroke. When the cutoff values for the sum of opening inner diameters, the blood flow velocity and the sum of depths in LAA were set as≤71 mm, ≤41 cm/s and≥103 mm, the sensitivity and specificity of each parameter for stroke predication were 91% and 83%, 79% and 46%, 74% and 89% respectively. Conclusion: The incidenceof cardiogenic stroke is associated with anatomic features of LAA, such as cactus- or auliflower-shaped LAA, the sum of opening inner diameters and depths of LAA, and blood flow velocity in LAA. Evaluation of anatomy and function of LAA might facilitate stroke prediction as a supplement of CHA₂DS₂VASc score in patients with AF.

Key words: Transesophageal echocardiography, Left atrial appendage anatomy, Atrial fibrillation, Stroke

CLC Number:

R541.7

WANG Chenchen, YANG Wenbo, HUA Wei, CHEN Yefen, SU Xiuxiu, GONG Junshi, FANG Yuehua. The morphology and function of left atrial appendage in the risk assessment of stroke in patients with non-valvular atrial fibrillation[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(02): 151-156.

Figures/Tables 9

References 14

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指标	非脑卒中组（n=153）	脑卒中组（n=70）	t或χ²值	P值
性别（男）	61.4%	62.9%	0.4	0.880
年龄（岁）	61.5±9.3	66.3±7.0	-4.2	<0.001
BMI（kg/m²）	24.8±3.0	25.1±3.0	-0.7	0.520
高血压病	71（46.4）	52（74.3）	15.1	<0.001
糖尿病	20（13.1）	23（32.9）	12.1	<0.001
肾小球滤过率[mL/（min·1.73 m²）]	88.1±12.7	72.3±13.4	8.2	<0.001
CHA₂DS₂VASc评分	1.5±1.1	3.1±1.3	-9.2	<0.001
收缩压（mmHg）	130.6±20.2	133.6±20.3	-1.0	0.310
舒张压（mmHg）	77.1±12.5	77.3±14.2	-0.7	0.950
持续性房颤	55（35.9)	51（72.9）	26.2	<0.001
LVEF(%)	64.2±7.2	65.1±7.6	-0.8	0.410
左心房内径(mm)	41.0±4.0	43.7±3.9	-3.9	<0.001
右心房增大	31（20.3）	24（34.3）	5.1	0.030
二尖瓣反流（3~4分）	4（2.6）	1（1.4）	/	/
三尖瓣最大反流速度（m/s）	2.4±0.2	2.5±0.3	-1.5	0.130
抗凝药治疗^*	123（80.4）	60（85.7）	0.9	0.336
抗血小板治疗^*	15（9.8）	19（27.1）	11.2	0.001

左心耳分型	非脑卒中	脑卒中	总计
鸡翅型	102（75.6）	33（24.4）	135
仙人掌型	19（51.4）	18（48.6）	37
风向标型	21（87.5）	3（12.5）	24
菜花型	11（40.7）	16（59.3）	27
总计	153	70	223

指标	左心耳解剖结构	非脑卒中组（n=153）	脑卒中组（n=70）	t值	P值
开口内径（mm）	0°	20.2±3.0	18.2±4.7	3.2	0.020
	45°	19.5±2.4	17.1±4.0	4.7	<0.001
	90°	19.9±2.7	17.6±4.4	4.1	<0.001
	135°	21.4±3.0	18.8±4.8	4.3	<0.001
开口内径之和（mm）	-	81.0±9.1	71.7±16.5	4.5	<0.001
深度（mm）	0°	23.0±4.2	28.8±5.2	-9.0	<0.001
	45°	22.0±3.5	28.3±4.3	-11.5	<0.001
	90°	21.6±3.7	27.8±4.0	-11.3	<0.001
	135°	19.3±3.3	26.0±4.2	-11.8	<0.001
深度之和（mm）	-	85.9±12.2	111.0±14.9	-13.2	<0.001
深度/开口内径比值	0°	1.1±0.2	1.7±0.6	-8.0	<0.001
	45°	1.1±0.2	1.8±0.5	-9.9	<0.001
	90°	1.1±0.2	1.7±0.6	-8.4	<0.001
	135°	0.9±0.2	1.5±0.5	-9.5	<0.001
深度之和/开口之和比值	-	1.1±0.1	1.6±0.5	-9.8	<0.001
分叶数（个）	-	1.2±0.4	2.0±0.8	-8.0	<0.001

指标	曲线下面积	标准误	P值	95%置信区间
指标	曲线下面积	标准误	P值	下限	上限
左心耳开口内径（mm）
0°	0.630	0.045	0.002	0.542	0.719
45°	0.685	0.044	<0.001	0.600	0.771
90°	0.653	0.044	<0.001	0.567	0.739
135°	0.673	0.044	<0.001	0.587	0.760
各角度之和	0.672	0.044	<0.001	0.586	0.758
左心耳深度（mm）
0°	0.819	0.029	<0.001	0.762	0.876
45°	0.871	0.026	<0.001	0.820	0.922
90°	0.872	0.025	<0.001	0.823	0.920
135°	0.899	0.023	<0.001	0.855	0.944
各角度之和	0.905	0.021	<0.001	0.864	0.946
左心耳深度/开口内径比值
0°	0.831	0.033	<0.001	0.767	0.896
45°	0.892	0.027	<0.001	0.840	0.944
90°	0.854	0.030	<0.001	0.796	0.912
135°	0.871	0.031	<0.001	0.810	0.933
各角度之和	0.883	0.030	<0.001	0.825	0.941
左心耳血流速度（cm/s）	0.843	0.029	<0.001	0.787	0.900
年龄（岁）	0.644	0.038	0.001	0.570	0.718
左房内径（mm）	0.648	0.038	<0.001	0.573	0.722
CHA₂DS₂VASc评分（分）	0.813	0.030	<0.001	0.754	0.873
肾小球滤过率[mL/（min·1.73 m²）]	0.813	0.030	<0.001	0.754	0.873

指标	灵敏度（%）	特异度（%）
年龄（≥60岁）	88	37
CHA₂DS₂VASc评分（≥3分）	69	79
左房前后径（42 mm）	74	50
肾小球滤过率[≤81 mL/（min·1.73 m²）	76	74
开口内径之和（≤71 mm）	91	46
深度之和（≥103 mm）	79	89
深度之和/开口内径之和比值（≥1.3）	74	94
心耳内流速（≤41 cm/s）	83	74