Abstract
Background and purpose: While studies have stratified cardioembolic (CE) stroke risk by qualitative left
atrial appendage (LAA) morphology and biomarkers of atrial dysfunction, the quantitative
properties that underlie these observations are not well established. Accordingly,
we hypothesized that LAA volume and contrast density (attenuation) on computerized
tomography (CT) may capture the structural and hemodynamic processes that underlie
CE stroke risk. Methods: Data were collected from a single center prospective ischemic stroke database over
18 months and included all patients with ischemic stroke who previously underwent
routine, nongated, contrast enhanced thin-slice (≤2.5 mm) chest CT. Stroke subtype
was determined based on the inpatient diagnostic evaluation. LAA volume and attenuation
were determined from CT studies performed for various clinically appropriate indications.
Univariate and multivariable analyses were performed to determine factors associated
with ischemic stroke subtype, including known risk factors and biomarkers, as well
as LAA density and morphologic measures. Results: We identified 311 patients with a qualifying chest CT (119 CE subtype, 109 Embolic
Stroke of Undetermined Source (ESUS), and 83 non-CE). In unadjusted models, there
was an association between CE (versus non-CE) stroke subtype and LAA volume (OR per
mL increase 1.15, 95% CI 1.07-1.24, P < .001) and LAA density (4th quartile versus 1st quartile; OR 2.95, 95% CI 1.28-6.80,
P = .011), but not with ESUS (versus non-CE) subtype. In adjusted models, only the
association between LAA density and CE stroke subtype persisted (adjusted OR 3.71,
95% CI 1.37-10.08, P = .010). Conclusion: The LAA volume and density values on chest CT are associated with CE stroke subtype
but not ESUS subtype. Patients with ESUS and increased LAA volume or attenuation may
be a subgroup where the mechanism is CE and anticoagulation can be tested for secondary
stroke prevention.
Key Words
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Article info
Publication history
Published online: January 13, 2020
Accepted:
December 13,
2019
Received in revised form:
December 9,
2019
Received:
September 9,
2019
Footnotes
Sources of funding: This study was funded by the American Heart Association AHA Award #17MCPRP33670965.
Disclosures: Dr. Elkind discloses receiving personal compensation for consulting for Abbott; receiving personal compensation for writing chapters on stroke for UpToDate; and research funding from the BMS-Pfizer Alliance for Eliquis and from Roche for a federally-funded clinical trial of atrial cardiopathy and stroke prevention.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104604
Copyright
© 2019 Elsevier Inc. All rights reserved.
