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Front. Cardiovasc. Med. | doi: 10.3389/fcvm.2018.00131

Complex Left Atrial Appendage Morphology Is An Independent Risk Factor For Cryptogenic Ischemic Stroke

 Indranill Basu Ray1*, Deepthi Sudhakar2,  Gregory Schwing3, Domimique Monlezun3,  Lucy T. Zhang4, Sumit Shah5,  Deep Pujara6,  Kevin Ting2,  Nidal A. Rafeh3, Gholam Ali3, Mark Cassidy3, Kenneth Ellenbogen7, Glen Levine2,  Wilson Lam2, Nilesh Mathuria6, Mohammad Saeed2,  Thomas J. Bunch8, Sheryl Martin-Schild3, Michael Gold9, Arash Aryana10, Mehidi Razavi6 and Abdi Rasekh6
  • 1St Francis’ Hospital, Zambia
  • 2Baylor College of Medicine, United States
  • 3Tulane University, United States
  • 4Rensselaer Polytechnic Institute, United States
  • 5University of Arkansas for Medical Sciences, United States
  • 6Texas Heart Institute, United States
  • 7Virginia Commonwealth University Health System, United States
  • 8Intermountain Medical Center, United States
  • 9University of South Carolina, United States
  • 10Mercy General Hospital, United States

Importance: Ischemic strokes pose a significant health burden. However, the etiology of between 20 to 40% of these events remains unknown. Left atrial appendage morphology may influence the occurrence of thromboembolic events.
Design: A retrospective cross-sectional study was conducted to investigate the role of LAA morphology in patients with atrial fibrillation (AF) and cardioembolic-associated stroke and patients with cryptogenic stroke without atrial fibrillation. LAA morphology is classified into two groups: 1) simple (chicken-wing) versus 2) complex (non-chicken wing) based on transesophageal echocardiography (TEE) findings. In addition to the LAA morphology, left atrial parameters, including orifice diameter, depth, emptying velocity, and filling velocity, were collected for both groups. Mathematical, computational models were constructed to investigate flow velocities in chicken-wing and non-chicken wing morphological patterns to assess LAA function further.
Findings: TEE values for volume, size, emptying, and filling velocities were similar between simple and complex LAA morphology groups. Patients with cryptogenic stroke without co-existing AF were noted to have significantly higher rates of complex LAA morphology. Chicken-wing LAA morphology was associated with four-fold higher flow rate (kg/s) in computational simulations.
Conclusions: Complex LAA morphology may be an independent contributing factor for cryptogenic strokes. Further studies are warranted to investigate the mechanism involved in LAA morphology and thromboembolic events.

Keywords: left atrial appendage (LAA), Left atrial appendage (LAA) closure, cryptogenic stroke, Atrial fibration, complex left atrial appendage morphology

Received: 23 Jun 2018; Accepted: 04 Sep 2018.

Edited by:

Ole De Backer, Rigshospitalet, Denmark

Reviewed by:

Masahiko Asami, Universitätsspital Bern, Switzerland
Luigi Biasco, Cardiocentro Ticino, Switzerland  

Copyright: © 2018 Basu Ray, Sudhakar, Schwing, Monlezun, Zhang, Shah, Pujara, Ting, Rafeh, Ali, Cassidy, Ellenbogen, Levine, Lam, Mathuria, Saeed, Bunch, Martin-Schild, Gold, Aryana, Razavi and Rasekh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Indranill Basu Ray, St Francis’ Hospital, Memphis, Zambia,