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J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1497-1501. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.036. Epub 2018 Feb 3.

Left Atrial Appendage Morphology and Embolic Stroke of Undetermined Source: A Cross-Sectional Multicenter Pilot Study.

Author information

1
Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
2
Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
3
Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
4
Department of Neurology, Yale University Medical Center, New Haven, Connecticut.
5
Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
6
Department of Radiology, Weill Cornell Medical College, New York, New York.
7
Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence Rhode Island.
8
Department of Internal Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
9
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
10
Departments of Neurology, Boston University Medical Center, Boston, Massachusetts.

Abstract

BACKGROUND:

The left atrial appendage (LAA) is the main source of thrombus in atrial fibrillation, and there is an association between non-chicken wing (NCW) LAA morphology and stroke. We hypothesized that the prevalence of NCW LAA morphology would be higher among patients with cardioembolic (CE) stroke and embolic stroke of undetermined source (ESUS) than among those with noncardioembolic stroke (NCS).

METHODS:

This multicenter retrospective pilot study included consecutive patients with ischemic stroke from 3 comprehensive stroke centers who previously underwent a qualifying chest computed tomography (CT) to assess LAA morphology. Patients underwent inpatient diagnostic evaluation for ischemic stroke, and stroke subtype was determined based on ESUS criteria. LAA morphology was determined using clinically performed contrast enhanced thin-slice chest CT by investigators blinded to stroke subtype. The primary predictor was NCW LAA morphology and the outcome was stroke subtype (CE, ESUS, NCS).

RESULTS:

We identified 172 patients with ischemic stroke who had a clinical chest CT performed. Mean age was 70.1 ± 14.3 years and 51.7% were male. Compared with patients with NCS, the prevalence of NCW LAA morphology was higher in patients with CE stroke (58.7% versus 46.3%, P = .1) and ESUS (58.8% versus 46.3%, P = .2), but this difference did not achieve statistical significance.

CONCLUSION:

The prevalence of NCW LAA morphology may be similar in patients with ESUS and CE, and may be higher than that in those with NCS. Larger studies are needed to confirm these associations.

KEYWORDS:

Cryptogenic stroke; atrial cardiopathy; atrial fibrillation; embolic stroke of undetermined source; ischemic stroke; left atrial appendage; morphology

[Indexed for MEDLINE]

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