Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation

Jung Myung Lee; Jaemin Shim; Jae Sun Uhm; Young Jin Kim; Hye Jeong Lee; Hui Nam Pak; Moon Hyoung Lee; Boyoung Joung

doi:10.1016/j.amjcard.2013.11.058

Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation

Jung Myung Lee, Jaemin Shim, Jae Sun Uhm, Young Jin Kim, Hye Jeong Lee, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journal › Article › peer-review

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Abstract

The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm², p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA₂DS₂-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm²) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm² (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.

Original language	English
Pages (from-to)	963-969
Number of pages	7
Journal	American Journal of Cardiology
Volume	113
Issue number	6
DOIs	https://doi.org/10.1016/j.amjcard.2013.11.058
Publication status	Published - 2014 Mar 15

Bibliographical note

Funding Information:
This study was supported in part by research grants of the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science and Technology ( 2012-0007604 , 2012-045367 ), and a grant of the Korean Healthcare technology R&D project, Ministry of Health & Welfare ( A121668 ). No other potential conflicts of interest relating to this article were reported.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.amjcard.2013.11.058

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@article{40b328cff453405db83bc661a0f2296c,

title = "Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation",

abstract = "The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm2, p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA2DS2-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm2) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm2 (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.",

author = "Lee, {Jung Myung} and Jaemin Shim and Uhm, {Jae Sun} and Kim, {Young Jin} and Lee, {Hye Jeong} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung",

note = "Funding Information: This study was supported in part by research grants of the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science and Technology ( 2012-0007604 , 2012-045367 ), and a grant of the Korean Healthcare technology R&D project, Ministry of Health & Welfare ( A121668 ). No other potential conflicts of interest relating to this article were reported. ",

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doi = "10.1016/j.amjcard.2013.11.058",

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T1 - Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation

AU - Lee, Jung Myung

AU - Shim, Jaemin

AU - Uhm, Jae Sun

AU - Kim, Young Jin

AU - Lee, Hye Jeong

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

N1 - Funding Information: This study was supported in part by research grants of the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science and Technology ( 2012-0007604 , 2012-045367 ), and a grant of the Korean Healthcare technology R&D project, Ministry of Health & Welfare ( A121668 ). No other potential conflicts of interest relating to this article were reported.

PY - 2014/3/15

Y1 - 2014/3/15

N2 - The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm2, p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA2DS2-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm2) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm2 (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.

AB - The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm2, p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA2DS2-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm2) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm2 (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.

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Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation

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