Left Atrial Appendage Morphology Assessment for Risk Stratification of Embolic Stroke in Patients with Atrial Fibrillation. A Meta-Analysis.
Background: Thromboembolic Event (TE) risk stratification is performed by using CHA2DS2Vasc Score. It has been suggested that left atrial appendage (LAA) morphology independently influences TE risk in patients with non-valvular atrial fibrillation (AF). The LAA morphology has been classified into four different types: Chicken Wing, Cauliflower, Windsock and Cactus.
Objective: To determine the TE risk for each LAA morphology in patients with AF with low-intermediate TE risk.
Methods: Systemic review of Medline, Cochrane, and Embase for studies that used computed tomography, 3D transesophageal echocardiography, and cardiac magnetic resonance to categorize the LAA morphologies with assessment of TE prevalence. Odds ratio (OR) and 95% confidence intervals (CI) were measured using Mantel-Haenzel method. Fixed-effect model was used and if heterogeneity (I2) was > 25, effects were analyzed using a random model.
Results: Eight studies with 2596 patients were included. 84% of patients had a CHADS2 score of <2. TE risk was lower in Chicken Wing when compared to non-Chicken Wing (OR, 0.46; 95% CI 0.36 to 0.58). Likewise, Chicken Wing had lower TE risk when compared to other morphologies (Chicken Wing vs Cauliflower- OR, 0.38; 95% CI 0.26 to 0.56; Chicken Wing vs Windsock-OR, 0.48, 95% CI 0.31 to 0.73; Chicken Wing vs Cactus- OR, 0.49; 95% CI 0.36 to 0.66).
Conclusion: Patients with Chicken Wing LAA morphology are less likely to develop TE when compared to patients with Non-Chicken Wing morphology. LAA morphology may be a valuable criteria in predicting TE and could impact the stratification and anticoagulation management of patients with low-intermediate risk.