Dataset Information

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study.

ABSTRACT:

Background

The significance of left atrial appendage (LAA) filling defects on early-phase cardiac computed tomography (CCT) remains uncertain. This study retrospectively investigated predictive factors of LAA filling defects on early-phase CCT.

Methods

A total of 68 patients with nonvalvular atrial fibrillation (AF) and early filling defect on CCT who underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were enrolled [48 males, 20 females; mean ± standard deviation (SD) age 62.72±8.13 years]. Additionally 68 sex- and age-matched patients with normal LAA filling were included as the control group. CCT, ultrasound, clinical and laboratory data were analyzed. Baseline data between groups were analyzed using t-, Mann-Whitney, and chi-squared tests. Multivariable logistic regression analysis was used to adjust for confounders. Pearson correlation analysis was used to confirm correlations between variables.

Results

Decreased LAA flow velocity [LAAFV; odds ratio (OR) =0.918; 95% confidence interval (CI): 0.883-0.954; P<0.001] and increased left atrial volume index (LAVI; OR =1.055; 95% CI: 1.012-1.099; P=0.011) were significantly associated with early-phase CCT LAA filling defects. The LAAFV threshold for predicting early LAA filling defects was 40.5 cm/s, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.905 (sensitivity 82.4%, specificity 91.2%); the LAVI predictive threshold was 58.77 mL/m² (AUC =0.840, sensitivity 85.3%, specificity 72.1%). A significant positive correlation was detected between LAAFV and the Hounsfield unit (HU) ratio of the LAA to ascending aorta on early-phase CCT (r=0.614; P<0.001), as well as the HU difference in LAA between early and delayed phase CCT (r=0.591; P<0.001). There were significant (P<0.05) differences in LAAFV between different filling defects.

Conclusions

Decreased LAAFV and increased LAVI are independent factors associated with LAA filling defects only on early-phase CCT. Early-phase CCT LAA filling defect is associated with LAA emptying dysfunction. These findings contribute to thrombosis risk stratification in patients with AF.

SUBMITTER: Liu XW

PROVIDER: S-EPMC9929375 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study.

Liu Xiao-Wei XW Tian Xin X Hu Jie J Ma Guo-Jing GJ Gao Bu-Lang BL Li Cai-Ying CY

Quantitative imaging in medicine and surgery 20230105 2

<h4>Background</h4>The significance of left atrial appendage (LAA) filling defects on early-phase cardiac computed tomography (CCT) remains uncertain. This study retrospectively investigated predictive factors of LAA filling defects on early-phase CCT.<h4>Methods</h4>A total of 68 patients with nonvalvular atrial fibrillation (AF) and early filling defect on CCT who underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were enrolled [48 males, 20 females; mean ...[more]

PMID: 36819270

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Project description:BackgroundLeft atrial appendage (LAA) slow-flow may increase the risk of ischemic stroke. We studied LAA attenuation on cardiac computed tomography in patients with acute ischemic stroke.Methods and resultsWe used data from a prospective cohort of patients with acute ischemic stroke undergoing cardiac computed tomography during the acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale: higher scores indicating worse outcome), stroke recurrence and major adverse cardiovascular events after 2-year follow-up between patients with LAA thrombus (filling defect<100 Hounsfield Unit (HU)), slow-flow (filling defect ≥100 HU) and normal filling. Of 421 patients, 31 (7%) had LAA thrombus, 69 (16%) slow-flow, and 321 (76%) normal filling. Patients with thrombus or slow-flow more often had known atrial fibrillation compared with normal filling (45%, 39%, and 9%, P<0.001). Patients with thrombus had higher National Institutes of Health Stroke Scale-scores compared with slow-flow and normal filling (18 [interquartile range, 9-22], 6 [interquartile range, 3-17], and 5 [interquartile range, 2-11], P<0.001). Compared with normal filling, there was no difference with slow-flow in functional outcome (median modified Rankin scale, 3 versus 2; acOR 0.8 [95% CI, 0.5-1.4]), stroke recurrence (adjusted hazard ratio, 0.8 [95% CI, 0.3-1.9]) or major adverse cardiovascular events (adjusted hazard ratio, 1.2 [95% CI, 0.7-2.1]), while patients with thrombus had worse functional outcome (median modified Rankin scale, 6, acOR, 3.3 [95% CI, 1.5-7.4]). In cryptogenic stroke patients (n=156) slow-flow was associated with stroke recurrence (27% versus 6%, aHR, 4.1 [95% CI, 1.1-15.7]).ConclusionsPatients with slow-flow had similar characteristics to patients with thrombus, but had less severe strokes. Slow-flow was not significantly associated with functional outcome or major adverse cardiovascular events, but was associated with recurrent stroke in patients with cryptogenic stroke.

Project description:ObjectivesThis meta-analysis was conducted to evaluate the efficacy and safety of transcatheter left atrial appendage (LAA) occlusion in patients with nonvalvular atrial fibrillation.MethodsThe randomized controlled trials (RCT) or observational studies with any transcatheter LAA occlusion devices were searched in PubMed, Embase, and Cochrane library from inception to November 2015. The incidence rates from individual studies were combined to evaluate the procedural efficacy and safety, including all-cause death, cardiac/neurological death, stroke, transient ischemic attack (TIA), thrombosis, hemorrhagic complications, and pericardial effusion/tamponade.ResultsThirty-eight studies involving 3585 patients and 6 different occlusion devices were eligible for our inclusion criteria. The procedural failure rate for LAA closure was 0.02 (95% CI: 0.02-0.03). The all-cause mortality was 0.03 (95% CI: 0.02-0.03) and cardiac/neurological mortality was 0 (95% CI: 0.00-0.01). The stroke/TIA rate was estimated only 0.01 (95% CI: 0.01-0.01). The incidence of thrombus on devices was 0.01 (95% CI: 0.01-0.02). The major hemorrhagic complication rate was estimated 0.01 (95% CI: 0.00-0.01). Pericardial effusion/tamponade was estimated 0.02 (95% CI: 0.02-0.03). No heterogeneity was observed for above pooled estimates (I = 0). In devices subgroups analysis, the all-cause mortality and cardiac/neurological mortality of PLAATO group were the highest (P = 0.01 and P < 0.01 respectively), whereas the incidence of thrombus on devices in the ACP group was the highest (P < 0.01). In follow-up period subgroups analysis, there were significant differences in all-cause death, stroke/TIA, major hemorrhage, and pericardial effusion/tamponade events between the shorter and longer follow-up period subgroups (P < 0.05). However, the differences among the subgroups were numerically small.Conclusionsthe pooled data demonstrated that transcatheter LAA occlusion was effective and safe in the patients with nonvalvular atrial fibrillation who were not suitable for lifelong antithrombotic therapy.

Dataset Information

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study.

Background

Methods

Results

Conclusions

Publications

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study.

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