title: Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation.
abstract: BACKGROUND
  Left atrial appendage (LAA) is the major source of cardiac thrombi in atrial fibrillation (AF) and plays a major role in cardioembolic events.
  
  
  OBJECTIVE
  To investigate the correlation between LAA morphology and the burden of silent cerebral ischemia (SCI) as a new thromboembolic risk marker in patients with AF.
  
  
  METHODS
  A total of 348 patients with AF undergoing transcatheter ablation were enrolled. A cerebral magnetic resonance (MR) was performed to assess SCI burden, while LAA morphology was studied by MR or computed tomography and categorized as follows: cactus in 52 (14.9%) patients, chicken wing in 177 (50.9%), wind sock in 101 (29.0%), and cauliflower in 18 (5.2%).
  
  
  RESULTS
  SCIs were detected in 295 (84.8%) patients, with a median number of lesions of 23. SCI burden was related to LAA complexity: 30.8% and 17.3% patients with cactus, 30.5% and 22.0% with chicken wing, 13.9% and 27.7% with wind sock, and 16.7% and 38.9% with cauliflower LAA morphologies were in the first and fourth quartiles of number of SCI per patient, respectively (P = .035). After adjustment for potential confounders, only age (β 0.12; 95% CI 0.08-0.16; P < .001), chicken wing (β -0.28; 95% CI -0.51 to -0.04; P = .021), wind sock (β 0.38; 95% CI 0.12-0.65; P = .005), and cauliflower (β 0.61; 95% CI 0.07-1.14; P = .026) LAA morphologies were significantly related to SCI burden.
  
  
  CONCLUSIONS
  LAA morphology relates to the burden of SCI in AF patients. Future research should corroborate if accessible methods (eg, echocardiography) are able to describe LAA morphology, permitting its use within universal thromboembolic risk predictors in AF patients.
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: Division of Cardiology, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Gili
authors.affiliation: Department of Biomedical Engineering, University of Texas, Austin, Texas.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Corsinovi
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Pianelli
authors.affiliation: Division of Radiology, Cardinal Guglielmo Massaia Hospital, Asti, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Cesarani
authors.affiliation: Division of Radiology, "Città della Salute e della Scienza" Hospital, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Faletti
authors.affiliation: Division of Radiology, "Città della Salute e della Scienza" Hospital, Turin, Italy.
authors.forename: Dorico
authors.initials: D
authors.lastname: Righi
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: gaitaf@gmail.it.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D020517:Atrial Appendage / Q000473:pathology*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: AF; Atrial fibrillation; CT; Cardiac computed tomography; Cardiac magnetic resonance; Cerebral magnetic resonance; LA; LAA; Left atrial appendage; MR; SCI; Silent cerebral ischemia; atrial fibrillation; computed tomography; left atrial appendage; left atrial/atrium; magnetic resonance; silent cerebral ischemia