Cardiovascular Disease |

Left Atrial Appendage Morphology and Stroke Risk in Atrial Fibrillation: A Meta-analysis of Observational Studies FREE TO VIEW

Vivek Yarlagadda, MD; Parinita Dherange, MD; Arun Kanmathareddy; Pradyumna Agasthi; Sampath Gunda; Dhanunjaya Lakkireddy, MD; Madhu Reddy, MD
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Atlanticare Regional Medical Center, Atlantic City, NJ

Chest. 2015;148(4_MeetingAbstracts):63A. doi:10.1378/chest.2271760
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SESSION TITLE: Cardiovascular Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Thromboembolism due to atrial fibrillation (AF) is a frequent cause of stroke. More than 90% of thrombi in AF form in the left atrial appendage (LAA). It has been suggested in a few studies that certain types of LAA morphology are at heightened risk for thromboembolism in AF patients. We aimed to systematically anlyze all the existing literature for association between LAA morphology and stroke risk.

METHODS: PubMed, EMBASE and Google Scholar databases were searched to identify all studies describing the different LAA morphologies and their association with stroke. Data from identified studies was extracted and meta-analysis was carried out using Revman 5.2 software. Pooled Odds ratios (OR) were calculated using Mantel-Haenszel random effects model. Between studies heterogeneity was assessed using the I2 statistic.

RESULTS: A total of 3 studies with 1690 subjects met our inclusion and exclusion criteria and were included in the final analysis. The Chicken wing, Cactus, Windsock and Cauliflower type of LAA morphology was seen in 45%, 24%, 23% and 7% of the patients, respectively. The Chicken wing type LAA was associated with low risk of stroke (OR 0.47, 95% CI0.28 -0.80) compared to non-chicken wing LAA. Further, the Cauliflower type increased stroke risk compared to other types (OR 2.45, 95% CI 1.48-4.06) and Cactus type also was associated with increased risk of stroke (OR 1.76, 95% CI 1.22-2.54). The Windsock type of LAA did not increase the risk of stroke compared to other LAA types (OR 0.83, 95% CI 0.42-1.63).

CONCLUSIONS: The non-Chicken wing type of LAA morphologies increases the risk of thromboembolism in AF.

CLINICAL IMPLICATIONS: Assessment of LAA morphology may aid in risk stratifying the patients at heightened risk for thromboembolism in AF.

DISCLOSURE: The following authors have nothing to disclose: Vivek Yarlagadda, Parinita Dherange, Arun Kanmathareddy, Pradyumna Agasthi, Sampath Gunda, Dhanunjaya Lakkireddy, Madhu Reddy

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