scholarly journals Post-angiography Retention of the Contrast Agent in the Left Atrial Appendage Is Associated With Risk of Cardioembolic Stroke in Patients With Atrial Fibrillation: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Ping Fang ◽  
Youquan Wei ◽  
Jinfeng Wang ◽  
Xianghai Wang ◽  
Hao Yang
Keyword(s):  
Atrial Fibrillation ◽  
Retrospective Study ◽  
Contrast Agent ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Relative Proportion ◽  
Multivariate Logistic Regression Analysis ◽  
Atrial Appendage ◽  
Cardioembolic Stroke ◽  
Stroke Group

Background: Atrial fibrillation (AF) represents an important risk factor for cardioembolic stroke, and most atrial thrombi originate from the left atrial appendage (LAA). Although the CHA2DS2-VASc score is widely used to estimate the risk of cardioembolic stroke in AF patients, yet greatly affected by many factors. This study was undertaken to determine the association between contrast agent retention in LAA after LAA angiography and risks of cardioembolic stroke in patients with AF.Methods: This is a retrospective study. The demographic and clinical data of AF patients undergone left atrial appendage occlusion (LAAO) with or without catheter radiofrequency ablation were retrospectively analyzed. The patients were classified into either stroke or non-stroke group by the history with cardioembolic stroke or transient ischemic attack (TIA).Results: Sixty-two consecutive patients undergone LAAO were finally included, in whom 31 AF patients had a history of cardioembolic stroke or TIA (one TIA), and significantly higher CHA2DS2-VASc score (4.2 ± 1.4 vs. 3.3 ± 1.3; P = 0.006) as well as incidence of contrast agent retention in LAA (n = 20 vs. n = 7; P = 0.001) compared to the patients in non-stroke group. In addition, the relative proportion of distinctive morphological types of LAA was significantly different between groups (P < 0.001). Multivariate logistic regression analysis showed that higher CHA2DS2-VASc scores (OR = 1.7, 95% CI: 1.0–3.0, P = 0.046) and LAA contrast agent retention (OR = 5.1, 95% CI: 1.1–23.9, P = 0.002) were associated with increased risks of cardioembolic stroke. The patients with Windsock type LAA (OR = 7.8, 95% CI: 1.1–57.2, P = 0.044) and Cauliflower LAA (OR = 20.2, 95% CI: 3.2–125.5, P = 0.001) were more prone to cardioembolic stroke compared to those with Chicken Wing type LAA.Conclusion: Left atrial appendage contrast agent retention after LAA angiography is associated with the risks of cardioembolic stroke in patients with AF, and cardioembolic stroke is more seen in AF patients with Windsock or Cauliflower type LAA.

scholarly journals Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients with and without Prior Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Bin-Feng Mo ◽  
Rui Zhang ◽  
Jia-Li Yuan ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Control Group ◽  
Left Atrial Appendage Closure ◽  
Combined Procedure ◽  
Stroke Group ◽  
Prior Stroke

Background. Combined atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. Data of the combined procedure in selected patients with prior stroke are limited. The aim of this study is to compare the safety and efficacy of combined catheter ablation and LAAC between AF patients with and without prior stroke. Methods and Results. This retrospective study enrolled 296 patients who underwent combined procedures of AF ablation and LAAC. Patients were divided into two groups: 81 patients with prior stroke (Stroke group) and 215 patients without prior stroke (Control group). Combined procedures were successfully performed in all the patients. Patients in the Stroke group had higher CHA2DS2-VASc scores (4.9 ± 1.2 vs. 3.2 ± 1.0, P < 0.001 ) and higher HAS-BLED scores (3.5 ± 1.1 vs. 3.0 ± 1.0, P < 0.001 ) compared with those in the Control group. Procedure-related complications in the Stroke group included two pericardial effusions and two groin hematomas, which did not differ significantly fromthe Control group (4.9% vs. 4.2%, P = 0.778 ). After a mean follow-up of 20 months, the AF-free rate of the Stroke group was comparable with that of the Control group (64.2% vs. 68.4%, P = 0.495 ). The relative risk reductions in stroke and bleeding (observed rate compared to that predicted from the CHA2DS2-VASc and HAS-BLED scores) were 80% and 79%, respectively, in the Stroke group, and 62% and 62%, respectively, in the Control group. Conclusions. The combination of catheter ablation and LAAC is safe and efficient in selected AF patients with prior stroke. It was observed that patients with prior stroke may benefit more from risk reductions of stroke and bleeding following the combined procedure.

Left Atrial and Left Atrial Appendage Functional Abnormalities in Patients with Cardioembolic Stroke in Sinus Rhythm and Idiopathic Atrial Fibrillation

1998 ◽  
Vol 11 (7) ◽  
pp. 711-719 ◽  
Author(s):  
Konstantinos Panagiotopoulos ◽  
Savvas Toumanidis ◽  
Nikolaos Saridakis ◽  
Konstantinos Vemmos ◽  
Spyridon Moulopoulos
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Cardioembolic Stroke

Left Atrial Appendage Function in Patients with Cardioembolic Stroke in Sinus Rhythm and Atrial Fibrillation

2000 ◽  
Vol 13 (7) ◽  
pp. 661-665 ◽  
Author(s):  
Necla Özer ◽  
Lale Tokgözoğlu ◽  
Kenan Övünç ◽  
Giray Kabakçı ◽  
Serdar Aksöyek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Cardioembolic Stroke

scholarly journals Biomarkers for Predicting Left Atrial or Left Atrial Appendage Thrombus in Anticoagulated Patients with Nonvalvular Atrial Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Xue Zhou ◽  
Zuolan Wang ◽  
Shuang Dou ◽  
Kangyin Chen ◽  
Enzhao Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Multivariate Logistic Regression Analysis ◽  
Atrial Appendage ◽  
Multivariate Logistic Regression ◽  
Nonvalvular Atrial Fibrillation ◽  
Distribution Width ◽  
Cutoff Value

Purpose. Although atrial fibrillation (AF) is often associated with thromboembolic complications, there is no definite biomarker for detecting the presence of thrombi in the left atrial (LA) or left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Methods. NVAF patients who underwent transesophageal echocardiography (TEE) to evaluate LA/LAA thrombus and spontaneous echo contrast (SEC) before AF ablation were included. Multivariate logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the independent risk factors of LA/LAA thrombus and indicate the best cutoff point. Results. Of the 260 consecutive subjects (mean age: 63.67 ± 9.39 years; 42% women), 45 (17.3%) patients were with LA/LAA thrombus, 131 (50.4%) were with SEC, and 84 (32.3%) were with neither thrombus nor SEC. The results of multivariate logistic regression analysis showed that N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 2.179; 95% CI: 1.191–3.987; p=0.012) and red cell distribution width (RDW) (OR, 2.398; 95% CI: 1.075–5.349; p=0.033) were independently correlated with the presence of LA/LAA thrombus but not D-dimer (OR, 0.999; 95% CI: 0.998–1.000; p=0.210). When all patients were divided into four groups based on the combination between RDW (cutoff value: 12.95%) and NT-proBNP levels (cutoff value: 368.9 ng/L), the rate of LA/LAA thrombus was the highest in the high RDW and NT-proBNP group. Conclusion. In anticoagulation patients with NVAF, elevated NT-proBNP and RDW are related to LA/LAA thrombus. Therefore, these might be considered as useful prognostic markers in the management and treatment of NVAF patients.

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