Left Atrial Appendage Function and Stroke Risk

Shadi Yaghi, Christopher Song, William A Gray, Karen L Furie, Mitchell S V Elkind, Hooman Kamel, Shadi Yaghi, Christopher Song, William A Gray, Karen L Furie, Mitchell S V Elkind, Hooman Kamel

No abstract available

Keywords: anticoagulants; atrial appendage; atrial fibrillation; cryptogenic stroke; stroke risk.

Figures

Figure
Figure
Left Atrial Appendage Dysfunction as a Cause of Embolic Stroke

References

    1. Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes: A population-based study of incidence and risk factors. Stroke. 1999;30:2513–2516.
    1. Sacco RL, Ellenberg JH, Mohr JP, Tatemichi TK, Hier DB, Price TR, et al. Infarcts of undetermined cause: The nincds stroke data bank. Ann Neurol. 1989;25:382–390.
    1. Kamel H, Okin PM, Longstreth WT, Jr., Elkind MS, Soliman EZ. Atrial cardiopathy: A broadened concept of left atrial thromboembolism beyond atrial fibrillation. Future Cardiol. 2015;11:323–331.
    1. Yaghi S, Elkind MS. Cryptogenic stroke: A diagnostic challenge. Neurol Clin Pract. 2014;4:386–393.
    1. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, et al. Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurol. 2014;13:429–438.
    1. Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478–2486.
    1. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014;370:2467–2477.
    1. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42:517–584.
    1. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366:120–129.
    1. Brambatti M, Connolly SJ, Gold MR, Morillo CA, Capucci A, Muto C, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129:2094–2099.
    1. Sinner MF, Stepas KA, Moser CB, Krijthe BP, Aspelund T, Sotoodehnia N, et al. B-type natriuretic peptide and c-reactive protein in the prediction of atrial fibrillation risk: The charge-af consortium of community-based cohort studies. Europace. 2014;16:1426–1433.
    1. Folsom AR, Nambi V, Bell EJ, Oluleye OW, Gottesman RF, Lutsey PL, et al. Troponin t, n-terminal pro-b-type natriuretic peptide, and incidence of stroke: The atherosclerosis risk in communities study. Stroke. 2013;44:961–967.
    1. Cushman M, Judd SE, Howard VJ, Kissela B, Gutierrez OM, Jenny NS, et al. N-terminal pro-b-type natriuretic peptide and stroke risk: The reasons for geographic and racial differences in stroke cohort. Stroke. 2014;45:1646–1650.
    1. Kamel H, Elkind MS, Bhave PD, Navi BB, Okin PM, Iadecola C, et al. Paroxysmal supraventricular tachycardia and the risk of ischemic stroke. Stroke. 2013;44:1550–1554.
    1. Kamel H, Soliman EZ, Heckbert SR, Kronmal RA, Longstreth WT, Jr., Nazarian S, et al. P-wave morphology and the risk of incident ischemic stroke in the multi-ethnic study of atherosclerosis. Stroke. 2014;45:2786–2788.
    1. Kamel H, O'Neal WT, Okin PM, Loehr LR, Alonso A, Soliman EZ. Electrocardiographic left atrial abnormality and stroke subtype in aric. [Jul 15, 2015];Ann Neurol. 2015 [published online ahead of print July 15, 2015] .
    1. Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999;30:2019–2024.
    1. Yaghi S, Moon YP, Mora-McLaughlin C, Willey JZ, Cheung K, Di Tullio MR, et al. Left atrial enlargement and stroke recurrence: The northern manhattan stroke study. Stroke. 2015;46:1488–1493.
    1. Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: Structure, function, and role in thromboembolism. Heart. 1999;82:547–554.
    1. Davis CA, 3rd, Rembert JC, Greenfield JC., Jr Compliance of left atrium with and without left atrium appendage. Am J Physiol. 1990;259:H1006–1008.
    1. Chapeau C, Gutkowska J, Schiller PW, Milne RW, Thibault G, Garcia R, et al. Localization of immunoreactive synthetic atrial natriuretic factor (anf) in the heart of various animal species. J Histochem Cytochem. 1985;33:541–550.
    1. Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: A transesophageal echocardiographic study. J Am Coll Cardiol. 1995;25:452–459.
    1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755–759.
    1. Brott TG. Novel approaches to stroke prevention in atrial fibrillation: Introduction. Stroke. 2007;38:614.
    1. Romero J, Cao JJ, Garcia MJ, Taub CC. Cardiac imaging for assessment of left atrial appendage stasis and thrombosis. Nat Rev Cardiol. 2014;11:470–480.
    1. Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ. The left atrial appendage: Anatomy, function, and noninvasive evaluation. JACC Cardiovasc Imaging. 2014;7:1251–1265.
    1. Veinot JP, Harrity PJ, Gentile F, Khandheria BK, Bailey KR, Eickholt JT, et al. Anatomy of the normal left atrial appendage: A quantitative study of age-related changes in 500 autopsy hearts: Implications for echocardiographic examination. Circulation. 1997;96:3112–3115.
    1. Yamamoto M, Seo Y, Kawamatsu N, Sato K, Sugano A, Machino-Ohtsuka T, et al. Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging. 2014;7:337–343.
    1. Petersen M, Roehrich A, Balzer J, Shin DI, Meyer C, Kelm M, et al. Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation. Europace. 2015;17:539–545.
    1. Di Biase L, Santangeli P, Anselmino M, Mohanty P, Salvetti I, Gili S, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012;60:531–538.
    1. Jue J, Winslow T, Fazio G, Redberg RF, Foster E, Schiller NB. Pulsed doppler characterization of left atrial appendage flow. J Am Soc Echocardiogr. 1993;6:237–244.
    1. Uretsky S, Shah A, Bangalore S, Rosenberg L, Sarji R, Cantales DR, et al. Assessment of left atrial appendage function with transthoracic tissue doppler echocardiography. Eur J Echocardiogr. 2009;10:363–371.
    1. Fukuda N, Shinohara H, Sakabe K, Onose Y, Nada T, Tamura Y. Transthoracic doppler echocardiographic measurement of left atrial appendage blood flow velocity: Comparison with transoesophageal measurement. Eur J Echocardiogr. 2003;4:191–195.
    1. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. 2011 accf/aha/hrs focused updates incorporated into the acc/aha/esc 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology foundation/american heart association task force on practice guidelines developed in partnership with the european society of cardiology and in collaboration with the european heart rhythm association and the heart rhythm society. J Am Coll Cardiol. 2011;57:e101–198.
    1. Acar J, Cormier B, Grimberg D, Kawthekar G, Iung B, Scheuer B, et al. Diagnosis of left atrial thrombi in mitral stenosis--usefulness of ultrasound techniques compared with other methods. Eur Heart J. 1991;12(Suppl B):70–76.
    1. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med. 1995;123:817–822.
    1. Ono M, Asanuma T, Tanabe K, Yoshitomi H, Shimizu H, Ohta Y, et al. Improved visualization of the left atrial appendage by transthoracic 2-dimensional tissue harmonic compared with fundamental echocardiographic imaging. J Am Soc Echocardiogr. 1998;11:1044–1049.
    1. Sallach JA, Puwanant S, Drinko JK, Jaffer S, Donal E, Thambidorai SK, et al. Comprehensive left atrial appendage optimization of thrombus using surface echocardiography: The clots multicenter pilot trial. J Am Soc Echocardiogr. 2009;22:1165–1172.
    1. Bellotti P, Spirito P, Lupi G, Vecchio C. Left atrial appendage function assessed by transesophageal echocardiography before and on the day after elective cardioversion for nonvalvular atrial fibrillation. Am J Cardiol. 1998;81:1199–1202.
    1. Warraich HJ, Gandhavadi M, Manning WJ. Mechanical discordance of the left atrium and appendage: A novel mechanism of stroke in paroxysmal atrial fibrillation. Stroke. 2014;45:1481–1484.
    1. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Mohanty S, Horton R, et al. Left atrial appendage: An underrecognized trigger site of atrial fibrillation. Circulation. 2010;122:109–118.
    1. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23:961–969.
    1. Kamalesh M, Copeland TB, Sawada S. Severely reduced left atrial appendage function: A cause of embolic stroke in patients in sinus rhythm? J Am Soc Echocardiogr. 1998;11:902–904.
    1. Lee JM, Shim J, Uhm JS, Kim YJ, Lee HJ, Pak HN, et al. Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation. Am J Cardiol. 2014;113:963–969.
    1. Goldman ME, Pearce LA, Hart RG, Zabalgoitia M, Asinger RW, Safford R, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (the stroke prevention in atrial fibrillation [spaf-iii] study). J Am Soc Echocardiogr. 1999;12:1080–1087.
    1. Lee JM, Seo J, Uhm JS, Kim YJ, Lee HJ, Kim JY, et al. Why is left atrial appendage morphology related to strokes? An analysis of the flow velocity and orifice size of the left atrial appendage. [Jul 30th, 2015];J Cardiovasc Electrophysiol. 2015 [published online ahead of print May 11, 2015] .
    1. Kimura T, Takatsuki S, Inagawa K, Katsumata Y, Nishiyama T, Nishiyama N, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low chads2 scores. Heart Rhythm. 2013;10:921–925.
    1. Anselmino M, Scaglione M, Di Biase L, Gili S, Santangeli P, Corsinovi L, et al. Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation. Heart Rhythm. 2014;11:2–7.
    1. Khurram IM, Dewire J, Mager M, Maqbool F, Zimmerman SL, Zipunnikov V, et al. Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation. Heart Rhythm. 2013;10:1843–1849.
    1. Akoum N, Marrouche N. Assessment and impact of cardiac fibrosis on atrial fibrillation. Curr Cardiol Rep. 2014;16:518.
    1. Fukushima K, Fukushima N, Kato K, Ejima K, Sato H, Fukushima K, et al. Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation. [July 30th, 2015];Eur Heart J Cardiovasc Imaging. 2015 [published online ahead of print May, 5th 2015] .
    1. Kishima H, Mine T, Ashida K, Sugahara M, Kodani T, Masuyama T. Does left atrial appendage morphology influence left atrial appendage flow velocity? [July 30th, 2015];Circ J. 2015 [Published online ahead of print May 9th, 2015] .
    1. Akoum N, Fernandez G, Wilson B, McGann C, Kholmovski E, Marrouche N. Association of atrial fibrosis quantified using lge-mri with atrial appendage thrombus and spontaneous contrast on transesophageal echocardiography in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24:1104–1109.
    1. Di Biase L, Santangeli P, Gaita F, Natale A. Reply: To pmid 22858289. J Am Coll Cardiol. 2013;61:690–691.
    1. Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber K, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the protect af (watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial. Circulation. 2013;127:720–729.
    1. Reddy VY, Sievert H, Halperin J, Doshi SK, Buchbinder M, Neuzil P, et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: A randomized clinical trial. JAMA. 2014;312:1988–1998.
    1. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2014;45:2160–2236.
    1. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444–1451.
    1. Longstreth WT, Jr., Kronmal RA, Thompson JL, Christenson RH, Levine SR, Gross R, et al. Amino terminal pro-b-type natriuretic peptide, secondary stroke prevention, and choice of antithrombotic therapy. Stroke. 2013;44:714–719.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren