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Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke.

Publication ,  Journal Article
Chang, AD; Ignacio, GC; Akiki, R; Grory, BM; Cutting, SS; Burton, T; Jayaraman, M; Merkler, A; Song, C; Poppas, A; Kamel, H; Elkind, MSV ...
Published in: J Stroke Cerebrovasc Dis
April 2020

BACKGROUND AND PURPOSE: While studies have stratified cardioembolic (CE) stroke risk by qualitative left atrial appendage (LAA) morphology and biomarkers of atrial dysfunction, the quantitative properties that underlie these observations are not well established. Accordingly, we hypothesized that LAA volume and contrast density (attenuation) on computerized tomography (CT) may capture the structural and hemodynamic processes that underlie CE stroke risk. METHODS: Data were collected from a single center prospective ischemic stroke database over 18 months and included all patients with ischemic stroke who previously underwent routine, nongated, contrast enhanced thin-slice (≤2.5 mm) chest CT. Stroke subtype was determined based on the inpatient diagnostic evaluation. LAA volume and attenuation were determined from CT studies performed for various clinically appropriate indications. Univariate and multivariable analyses were performed to determine factors associated with ischemic stroke subtype, including known risk factors and biomarkers, as well as LAA density and morphologic measures. RESULTS: We identified 311 patients with a qualifying chest CT (119 CE subtype, 109 Embolic Stroke of Undetermined Source (ESUS), and 83 non-CE). In unadjusted models, there was an association between CE (versus non-CE) stroke subtype and LAA volume (OR per mL increase 1.15, 95% CI 1.07-1.24, P < .001) and LAA density (4th quartile versus 1st quartile; OR 2.95, 95% CI 1.28-6.80, P = .011), but not with ESUS (versus non-CE) subtype. In adjusted models, only the association between LAA density and CE stroke subtype persisted (adjusted OR 3.71, 95% CI 1.37-10.08, P = .010). CONCLUSION: The LAA volume and density values on chest CT are associated with CE stroke subtype but not ESUS subtype. Patients with ESUS and increased LAA volume or attenuation may be a subgroup where the mechanism is CE and anticoagulation can be tested for secondary stroke prevention.

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Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

April 2020

Volume

29

Issue

4

Start / End Page

104604

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
 

Citation

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Chang, A. D., Ignacio, G. C., Akiki, R., Grory, B. M., Cutting, S. S., Burton, T., … Yaghi, S. (2020). Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke. J Stroke Cerebrovasc Dis, 29(4), 104604. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104604
Chang, Andrew D., Gian C. Ignacio, Ronald Akiki, Brian Mac Grory, Shawna S. Cutting, Tina Burton, Mahesh Jayaraman, et al. “Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke.J Stroke Cerebrovasc Dis 29, no. 4 (April 2020): 104604. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104604.
Chang AD, Ignacio GC, Akiki R, Grory BM, Cutting SS, Burton T, et al. Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke. J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104604.
Chang, Andrew D., et al. “Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke.J Stroke Cerebrovasc Dis, vol. 29, no. 4, Apr. 2020, p. 104604. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2019.104604.
Chang AD, Ignacio GC, Akiki R, Grory BM, Cutting SS, Burton T, Jayaraman M, Merkler A, Song C, Poppas A, Kamel H, Elkind MSV, Furie K, Atalay M, Yaghi S. Increased Left Atrial Appendage Density on Computerized Tomography is Associated with Cardioembolic Stroke. J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104604.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

April 2020

Volume

29

Issue

4

Start / End Page

104604

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Neurology & Neurosurgery
  • Middle Aged
  • Male