Left atrial appendage morphology predicts the formation of left atrial appendage thrombus
Background Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology. Objective Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2021-04, Vol.32 (4), p.1044-1052 |
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| creator | Negrotto, Sara M. Lugo, Ricardo M. Metawee, Mohamed Kanagasundram, Arvindh N. Chidsey, Geoffrey Baker, Michael T. Michaud, Gregory F. Piana, Robert N. Benjamin Shoemaker, Moore Ellis, Christopher Randall |
| description | Background
Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology.
Objective
Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting rhythm, left ventricular ejection fraction (LVEF), or anticoagulant use.
Methods
A cross‐sectional analysis was performed on patients prospectively enrolled in the Vanderbilt LAA Registry or presenting for transesophageal echocardiogram (TEE) between January 1, 2015, and November 1, 2017 (n = 306). Two physicians independently reviewed TEEs interpreted as having LAA thrombus. Determination of LAA morphology, ejection velocity, and presence of thrombus (n = 102) were based on 0°, 45°, 90°, and 135° TEE views. The control cohort (n = 204) included consecutive AF patients undergoing TEE without LAA thrombus.
Results
LAA morphology in patients with LAA thrombus was: 35% windsock, 47% broccoli, and 12% CW. Windsock (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7–9.3, p = .001) and broccoli (OR, 6.6; 95% CI: 2.6–16.6; p |
| doi_str_mv | 10.1111/jce.14922 |
| format | Article |
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Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology.
Objective
Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting rhythm, left ventricular ejection fraction (LVEF), or anticoagulant use.
Methods
A cross‐sectional analysis was performed on patients prospectively enrolled in the Vanderbilt LAA Registry or presenting for transesophageal echocardiogram (TEE) between January 1, 2015, and November 1, 2017 (n = 306). Two physicians independently reviewed TEEs interpreted as having LAA thrombus. Determination of LAA morphology, ejection velocity, and presence of thrombus (n = 102) were based on 0°, 45°, 90°, and 135° TEE views. The control cohort (n = 204) included consecutive AF patients undergoing TEE without LAA thrombus.
Results
LAA morphology in patients with LAA thrombus was: 35% windsock, 47% broccoli, and 12% CW. Windsock (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7–9.3, p = .001) and broccoli (OR, 6.6; 95% CI: 2.6–16.6; p < .001) morphology were higher risk for thrombus compared to CW. Female sex predicted higher‐odds for LAA thrombus (OR, 2.6; 95% CI: 1.4–4.8; p = .002) as did LAA‐EV < 20 cm/s (OR, 11.12; 95% CI: 5.6–22.1). Anticoagulation use (OR, 0.5; 95% CI: 0.3–0.9; p = .03) and higher LVEF (OR, 0.95; 95% CI: 0.93–0.98; p < .001) were associated with lower risk. In patients with a CW morphology who had LAA thrombus, 4 of the 7 had an LAA‐EV < 20 cm/s and acute systolic heart failure with LVEF < 30% or active malignancy. In multivariable linear regression analysis controlling for presenting rhythm, anticoagulant use, age, sex, and LVEF, CW morphology appears relatively protective from LAA thrombus (p = .001).
Conclusion
CW LAA morphology appears relatively protective against the formation of LAA thrombus.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14922</identifier><identifier>PMID: 33512055</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Anticoagulants ; atrial fibrillation ; Blood clots ; Congestive heart failure ; Echocardiography ; Fibrillation ; left atrial appendage morphology ; left atrial appendage thrombus ; Malignancy ; Morphology ; Sex ; stroke ; Thrombosis ; transesophageal echocardiography ; Ventricle</subject><ispartof>Journal of cardiovascular electrophysiology, 2021-04, Vol.32 (4), p.1044-1052</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-8972ce58f42742de12a741a9ddea47edd4b20c51da8d162e26362c0a0a0d78c23</citedby><cites>FETCH-LOGICAL-c3532-8972ce58f42742de12a741a9ddea47edd4b20c51da8d162e26362c0a0a0d78c23</cites><orcidid>0000-0003-1300-0424 ; 0000-0001-6824-7155 ; 0000-0002-7333-5720</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.14922$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.14922$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33512055$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Negrotto, Sara M.</creatorcontrib><creatorcontrib>Lugo, Ricardo M.</creatorcontrib><creatorcontrib>Metawee, Mohamed</creatorcontrib><creatorcontrib>Kanagasundram, Arvindh N.</creatorcontrib><creatorcontrib>Chidsey, Geoffrey</creatorcontrib><creatorcontrib>Baker, Michael T.</creatorcontrib><creatorcontrib>Michaud, Gregory F.</creatorcontrib><creatorcontrib>Piana, Robert N.</creatorcontrib><creatorcontrib>Benjamin Shoemaker, Moore</creatorcontrib><creatorcontrib>Ellis, Christopher Randall</creatorcontrib><title>Left atrial appendage morphology predicts the formation of left atrial appendage thrombus</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Background
Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology.
Objective
Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting rhythm, left ventricular ejection fraction (LVEF), or anticoagulant use.
Methods
A cross‐sectional analysis was performed on patients prospectively enrolled in the Vanderbilt LAA Registry or presenting for transesophageal echocardiogram (TEE) between January 1, 2015, and November 1, 2017 (n = 306). Two physicians independently reviewed TEEs interpreted as having LAA thrombus. Determination of LAA morphology, ejection velocity, and presence of thrombus (n = 102) were based on 0°, 45°, 90°, and 135° TEE views. The control cohort (n = 204) included consecutive AF patients undergoing TEE without LAA thrombus.
Results
LAA morphology in patients with LAA thrombus was: 35% windsock, 47% broccoli, and 12% CW. Windsock (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7–9.3, p = .001) and broccoli (OR, 6.6; 95% CI: 2.6–16.6; p < .001) morphology were higher risk for thrombus compared to CW. Female sex predicted higher‐odds for LAA thrombus (OR, 2.6; 95% CI: 1.4–4.8; p = .002) as did LAA‐EV < 20 cm/s (OR, 11.12; 95% CI: 5.6–22.1). Anticoagulation use (OR, 0.5; 95% CI: 0.3–0.9; p = .03) and higher LVEF (OR, 0.95; 95% CI: 0.93–0.98; p < .001) were associated with lower risk. In patients with a CW morphology who had LAA thrombus, 4 of the 7 had an LAA‐EV < 20 cm/s and acute systolic heart failure with LVEF < 30% or active malignancy. In multivariable linear regression analysis controlling for presenting rhythm, anticoagulant use, age, sex, and LVEF, CW morphology appears relatively protective from LAA thrombus (p = .001).
Conclusion
CW LAA morphology appears relatively protective against the formation of LAA thrombus.</description><subject>Anticoagulants</subject><subject>atrial fibrillation</subject><subject>Blood clots</subject><subject>Congestive heart failure</subject><subject>Echocardiography</subject><subject>Fibrillation</subject><subject>left atrial appendage morphology</subject><subject>left atrial appendage thrombus</subject><subject>Malignancy</subject><subject>Morphology</subject><subject>Sex</subject><subject>stroke</subject><subject>Thrombosis</subject><subject>transesophageal echocardiography</subject><subject>Ventricle</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp10LtOwzAUBmALgWgpDLwAisQCQ6iviTOiqtxUiQUGJsu1T9pUSR3sRKhvj0sLAwJ7sIfv_Dr6ETon-IbEM14ZuCG8oPQADYngOJUkyw_jH3ORMpmzAToJYYUxYRkWx2jAmCAUCzFEbzMou0R3vtJ1otsW1lYvIGmcb5eudotN0nqwlelC0i0hKZ1vdFe5deLKpP5ztFt618z7cIqOSl0HONu_I_R6N32ZPKSz5_vHye0sNUwwmsoipwaELDnNObVAqM450YW1oHkO1vI5xUYQq6UlGQWasYwarOO1uTSUjdDVLrf17r2H0KmmCgbqWq_B9UFRLpkkBSuKSC9_0ZXr_Tpup6jABd2WKaO63injXQgeStX6qtF-owhWW6Ji3-qr72gv9on9vAH7I78LjmC8Ax9VDZv_k9TTZLqL_ATNYolK</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Negrotto, Sara M.</creator><creator>Lugo, Ricardo M.</creator><creator>Metawee, Mohamed</creator><creator>Kanagasundram, Arvindh N.</creator><creator>Chidsey, Geoffrey</creator><creator>Baker, Michael T.</creator><creator>Michaud, Gregory F.</creator><creator>Piana, Robert N.</creator><creator>Benjamin Shoemaker, Moore</creator><creator>Ellis, Christopher Randall</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1300-0424</orcidid><orcidid>https://orcid.org/0000-0001-6824-7155</orcidid><orcidid>https://orcid.org/0000-0002-7333-5720</orcidid></search><sort><creationdate>202104</creationdate><title>Left atrial appendage morphology predicts the formation of left atrial appendage thrombus</title><author>Negrotto, Sara M. ; Lugo, Ricardo M. ; Metawee, Mohamed ; Kanagasundram, Arvindh N. ; Chidsey, Geoffrey ; Baker, Michael T. ; Michaud, Gregory F. ; Piana, Robert N. ; Benjamin Shoemaker, Moore ; Ellis, Christopher Randall</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-8972ce58f42742de12a741a9ddea47edd4b20c51da8d162e26362c0a0a0d78c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anticoagulants</topic><topic>atrial fibrillation</topic><topic>Blood clots</topic><topic>Congestive heart failure</topic><topic>Echocardiography</topic><topic>Fibrillation</topic><topic>left atrial appendage morphology</topic><topic>left atrial appendage thrombus</topic><topic>Malignancy</topic><topic>Morphology</topic><topic>Sex</topic><topic>stroke</topic><topic>Thrombosis</topic><topic>transesophageal echocardiography</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Negrotto, Sara M.</creatorcontrib><creatorcontrib>Lugo, Ricardo M.</creatorcontrib><creatorcontrib>Metawee, Mohamed</creatorcontrib><creatorcontrib>Kanagasundram, Arvindh N.</creatorcontrib><creatorcontrib>Chidsey, Geoffrey</creatorcontrib><creatorcontrib>Baker, Michael T.</creatorcontrib><creatorcontrib>Michaud, Gregory F.</creatorcontrib><creatorcontrib>Piana, Robert N.</creatorcontrib><creatorcontrib>Benjamin Shoemaker, Moore</creatorcontrib><creatorcontrib>Ellis, Christopher Randall</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Negrotto, Sara M.</au><au>Lugo, Ricardo M.</au><au>Metawee, Mohamed</au><au>Kanagasundram, Arvindh N.</au><au>Chidsey, Geoffrey</au><au>Baker, Michael T.</au><au>Michaud, Gregory F.</au><au>Piana, Robert N.</au><au>Benjamin Shoemaker, Moore</au><au>Ellis, Christopher Randall</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left atrial appendage morphology predicts the formation of left atrial appendage thrombus</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2021-04</date><risdate>2021</risdate><volume>32</volume><issue>4</issue><spage>1044</spage><epage>1052</epage><pages>1044-1052</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Background
Nonchicken wing left atrial appendage (LAA) morphology is associated with higher risk for stroke in patients with atrial fibrillation (AF) than chicken wing (CW) morphology.
Objective
Assess whether LAA morphology predicts the formation of LAA thrombus independent of age, sex, presenting rhythm, left ventricular ejection fraction (LVEF), or anticoagulant use.
Methods
A cross‐sectional analysis was performed on patients prospectively enrolled in the Vanderbilt LAA Registry or presenting for transesophageal echocardiogram (TEE) between January 1, 2015, and November 1, 2017 (n = 306). Two physicians independently reviewed TEEs interpreted as having LAA thrombus. Determination of LAA morphology, ejection velocity, and presence of thrombus (n = 102) were based on 0°, 45°, 90°, and 135° TEE views. The control cohort (n = 204) included consecutive AF patients undergoing TEE without LAA thrombus.
Results
LAA morphology in patients with LAA thrombus was: 35% windsock, 47% broccoli, and 12% CW. Windsock (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7–9.3, p = .001) and broccoli (OR, 6.6; 95% CI: 2.6–16.6; p < .001) morphology were higher risk for thrombus compared to CW. Female sex predicted higher‐odds for LAA thrombus (OR, 2.6; 95% CI: 1.4–4.8; p = .002) as did LAA‐EV < 20 cm/s (OR, 11.12; 95% CI: 5.6–22.1). Anticoagulation use (OR, 0.5; 95% CI: 0.3–0.9; p = .03) and higher LVEF (OR, 0.95; 95% CI: 0.93–0.98; p < .001) were associated with lower risk. In patients with a CW morphology who had LAA thrombus, 4 of the 7 had an LAA‐EV < 20 cm/s and acute systolic heart failure with LVEF < 30% or active malignancy. In multivariable linear regression analysis controlling for presenting rhythm, anticoagulant use, age, sex, and LVEF, CW morphology appears relatively protective from LAA thrombus (p = .001).
Conclusion
CW LAA morphology appears relatively protective against the formation of LAA thrombus.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33512055</pmid><doi>10.1111/jce.14922</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-1300-0424</orcidid><orcidid>https://orcid.org/0000-0001-6824-7155</orcidid><orcidid>https://orcid.org/0000-0002-7333-5720</orcidid></addata></record> |
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| source | Wiley Online Library All Journals |
| subjects | Anticoagulants atrial fibrillation Blood clots Congestive heart failure Echocardiography Fibrillation left atrial appendage morphology left atrial appendage thrombus Malignancy Morphology Sex stroke Thrombosis transesophageal echocardiography Ventricle |
| title | Left atrial appendage morphology predicts the formation of left atrial appendage thrombus |
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