Left atrial appendage filling defects restricted to the early phase of cardiac computed tomography is significantly associated with ischemic stroke

Xiao-Wei Liu; Li-Qun Yan; Guo-Shi Wang; Yu-Han Sun; Wen-Jun Bao; Hao-Wen Zhang; Lan Yang; Chen Chen; Meng-Ya Li; Lei Yang; Xu-Qian Zhang; Xin Tian; Cai-Ying Li

doi:10.1016/j.clinimag.2023.03.008

Left atrial appendage filling defects restricted to the early phase of cardiac computed tomography is significantly associated with ischemic stroke

Clin Imaging. 2023 Jun:98:16-21. doi: 10.1016/j.clinimag.2023.03.008. Epub 2023 Mar 17.

Authors

Xiao-Wei Liu¹, Li-Qun Yan¹, Guo-Shi Wang¹, Yu-Han Sun¹, Wen-Jun Bao¹, Hao-Wen Zhang¹, Lan Yang², Chen Chen³, Meng-Ya Li¹, Lei Yang¹, Xu-Qian Zhang⁴, Xin Tian⁵, Cai-Ying Li⁶

Affiliations

¹ Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
² Department of nuclear medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Radiology, Hebei General Hospital, Shijiazhuang, China.
⁴ Second Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
⁵ Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China. Electronic address: tianx25@139.com.
⁶ Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China. Electronic address: licaiying63@163.com.

PMID: 36989887
DOI: 10.1016/j.clinimag.2023.03.008

Abstract

Purpose: To investigate the relationship between filling defects in the left atrial appendage restricted to the early phase of cardiac computed tomography (CCT), and ischemic stroke in patients with atrial fibrillation (AF).

Materials and methods: A total of 152 patients with non-valvular AF were retrospectively enrolled and divided into two groups according to the stroke history, as confirmed by brain computed tomography (CT) or magnetic resonance imaging (MRI), as the non-stroke group (n = 89) and stroke group (n = 63), respectively. The numbers of patients with filling defects in the early phase of CCT images without thrombi were recorded. Morphological parameters of the LAA were measured for all participants. All patients with early-phase filling defects (n = 44) were assigned to two groups according to ischemic stroke history: the filling defects with stroke group (n = 28) and the filling defects without stroke group (n = 16). The clinical characteristics and LAA morphological parameters were compared.

Results: Univariate analysis showed that compared with the non-stroke group，LAA volume index and age were higher in the stroke group, and the ratio of early phase filling defect in LAA, hypertension and diabetes were also higher, in the meanwhile the LVEF and BMI were lower (P < 0.05).After adjusting confounding factors by the multivariate logistic regression analysis, filling defect was significantly related with stroke [odds ratio (OR): 4.339, 95% confidence interval (CI): 1.951-9.653, P = 0.000]. LAA morphological parameters were not significantly different between the filling defects with stroke group and the group without stroke.

Conclusion: AF patients with LAA non-thrombotic filling defects in the early-phase of CCT had an increased risk of ischemic stroke compared to those without filling defects. This finding may help to optimize stroke risk stratification in patients with AF.

Keywords: Atrial fibrillation; Cardiac computed tomography; Ischemic stroke; LAA filling defect; LAA volume; Left atrial appendage.

MeSH terms

Atrial Appendage* / diagnostic imaging
Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnostic imaging
Echocardiography, Transesophageal / adverse effects
Humans
Ischemic Stroke* / complications
Ischemic Stroke* / etiology
Multidetector Computed Tomography / methods
Retrospective Studies
Stroke* / etiology
Thrombosis* / etiology