Malignant Left Atrial Appendage Morphology: Current Classification vs H-L System

•LAA morphology was studied with cardiac CT scan in a series of malignant LAA.•A novel classification based on the angle of the main lobe was applied.•Most cases were classified as chicken wing and as high-risk (LAA-H) morphology.•LAA-H morphology was associated with a higher LA size.•Focusing in me...

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Published in:Journal of stroke and cerebrovascular diseases 2021-03, Vol.30 (3), p.105570-105570, Article 105570
Main Authors: Parra-Díaz, Paloma, Salido-Tahoces, Luisa, Pardo-Sanz, Ana, Beltrán-Corbellini, Álvaro, Rodríguez-Jorge, Fernando, Chico-García, Juan Luis, García-Madrona, Sebastián, Matute-Lozano, Consuelo, Vera-Lechuga, Rocío, Cruz-Culebras, Antonio, Masjuan, Jaime, DeFelipe-Mimbrera, Alicia
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Atrial Appendage - diagnostic imaging
Cardioembolic stroke
Classification system
Embolic Stroke - diagnostic imaging
Embolic Stroke - etiology
Female
Heart Diseases - complications
Heart Diseases - diagnostic imaging
Humans
Male
Malignant left atrial appendage
Middle Aged
Morphology
Predictive Value of Tests
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Terminology as Topic
Thromboembolism
Tomography, X-Ray Computed
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Summary:•LAA morphology was studied with cardiac CT scan in a series of malignant LAA.•A novel classification based on the angle of the main lobe was applied.•Most cases were classified as chicken wing and as high-risk (LAA-H) morphology.•LAA-H morphology was associated with a higher LA size.•Focusing in measurable features of the LAA may improve stratification of patients. In previous studies the risk of stroke recurrence has been associated with the left atrial appendage (LAA) morphology (non-chicken wing (NCW)), knowing those with a greater risk as malignant LAA. Recently, a simpler morphological classification has been suggested with two categories: Low-risk (LAA-L) and High-risk (LAA-H); which could be easier to apply and may correlate better with the risk of embolic stroke. Retrospective analysis from a registry of patients with recurrent cardioembolic strokes despite appropriate anticoagulant therapy, in which LAA morphology was studied with cardiac CT scan. LAA morphology was classified according to the four current categories and H-L morphology by the same cardiologist. Other variables associated with a high risk of stroke were also assessed, such as CHA2DS2-VASc score and left atrial (LA) size. Twenty-six cases were included in the analysis. We identified 22 (84.6%) chicken wing (CW), 1 (3.8%) windsock and 3 (11.5%) cactus by the current classification system, while 15 (57.7%) were classified as LAA-H and 11 (42.3%) as LAA-L by the new system. Half of the 22 cases with CW morphology were considered LAA-H, whereas all NCW were also classified as LAA-H. LA diameter and area were significantly higher in cases with LAA-H morphology (p=0.03 and 0.014), and also in those CW and LAA-H, compared to those CW with LAA-L (p=0.035). With this new classification system more than half of the cases of our malignant LAAs were classified as high-risk morphology. This morphology was also associated with an increased LA size.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2020.105570