Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage with fluid-structure interaction analysis

Runxin Fang; Zidun Wang; Xie Zhao; Jun Wang; Yang Li; Yanjuan Zhang; Qiang Chen; Jiaqiu Wang; Quanjun Liu; Minglong Chen; Zhiyong Li

doi:10.1016/j.compbiomed.2022.105897

Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage with fluid-structure interaction analysis

Comput Biol Med. 2022 Sep:148:105897. doi: 10.1016/j.compbiomed.2022.105897. Epub 2022 Jul 30.

Authors

Runxin Fang¹, Zidun Wang², Xie Zhao³, Jun Wang², Yang Li⁴, Yanjuan Zhang², Qiang Chen¹, Jiaqiu Wang⁵, Quanjun Liu¹, Minglong Chen⁶, Zhiyong Li⁷

Affiliations

¹ School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China.
² First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China.
³ School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China; Nanjing Drum-Tower Hospital, The Affiliated Hospital of Nanjing University Medicine School, Nanjing, 210008, China.
⁴ Zhongda Hospital, The Affiliated Hospital of Southeast University, Nanjing, 210009, China.
⁵ School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD4001, Australia.
⁶ First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China. Electronic address: chenminglong@njmu.edu.cn.
⁷ School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD4001, Australia. Electronic address: zylicam@gmail.com.

PMID: 35933962
DOI: 10.1016/j.compbiomed.2022.105897

Abstract

The majority of cardioembolic strokes in patients with non-valvular atrial fibrillation (NVAF) are resulted from clot formation in the left atrial appendage (LAA). Current stroke risk stratification is based on the overall risks estimated from demographic and clinical profiles but not on individual anatomy or physiology. We aim to explore the differences in LAA morphological and hemodynamic parameters by comparing patients with and without a stroke history. Thirty-nine patients with persistent NVAF were included. Of these, 17 patients without a stroke history (non-stroke group) were compared with 22 patients with a history of stroke (stroke group). Their LAA geometric models were first reconstructed, and the morphological parameters were then measured. Furthermore, their LAA hemodynamic parameters were calculated by fluid-structure interaction analysis. Moreover, particle residual rates (PRR) and blood renewal rates (BRR) analyses were also employed to characterize the thrombogenesis dynamics. The results showed that compared to the non-stroke group, the stroke group had significant smaller LAA tortuosity and LAA orifice area, and significantly lower LAA orifice velocities (0.16 ± 0.10 vs 0.15 ± 0.06 cm/s; p = 0.044), but higher PRR (14.58 ± 9.43 vs 9.25 ± 4.67; p = 0.040) and BRR (52.41 ± 18.11 vs 38.36 ± 24.07; p = 0.044). These LAA morphological and hemodynamic parameters may be used to assess stroke risk in patients with NVAF.

Keywords: Atrial fibrillation; Fluid-structure interaction; Hemodynamics; Left atrial appendage; Morphology; Stroke risk.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Appendage*
Atrial Fibrillation*
Echocardiography, Transesophageal
Humans
Risk Factors
Stroke*