title: Left atrial appendage morphology in patients with atrial fibrillation in China: implications for stroke risk assessment from a single center study.
abstract: BACKGROUND
  The left atrial appendage (LAA) is thought to be the main source of thrombi in patients with atrial fibrillation (AF). The purpose of this study was to describe the LAA orifice diameter, LAA length, and morphologic type of the LAA in Chinese patients with AF as well as to evaluate whether these LAA parameters are associated with a history of stroke in patients with AF from a single center in China.
  
  
  METHODS
  The study population consisted of 219 consecutive patients with drug-refractory, symptomatic paroxysmal, or persistent AF scheduled to undergo radiofrequency catheter ablation in our single center. All patients underwent extensive clinical assessment and multidetector computed tomography to fully explore the anatomy of the LAA.
  
  
  RESULTS
  Of the 219 patients who underwent catheter ablation procedures, chicken wing LAA morphology was found in 114 patients (52.2%), windsock in 52 (23.9%), cauliflower in 29 (13.0%), and cactus in 24 (10.9%). Compared with the windsock LAA morphology, cactus had a larger left atrial diameter ((42.40 ± 3.68) and (37.91 ± 4.32) mm, P = 0.005) and LAA orifice diameter ((27.38 ± 3.70) and (24.14 ± 3.58) mm, P = 0.048). The LAA length was significantly larger in the chicken wing morphology than in the windsock ((37.50 ± 6.74) and (31.33 ± 3.92) mm, P = 0.015) and cauliflower morphologies ((37.50 ± 6.74) and (31.33 ± 3.92) mm, P = 0.015). According to their medical records, 26 patients (11.9%) had suffered a prior stroke. Compared with patients who had no history of stroke, the prior-stroke patients were older (62.04 ± 8.07 and 58.24 ± 9.24, P = 0.047) and there were fewer patients with chicken wing (23.1% and 59.1%, P = 0.001) and more patients with cauliflower (26.9% and 9.8%, P = 0.046). Multivariate Logistic regression analysis demonstrated that age (odds ratio (OR) 1.26; 95% confidence interval (CI) 1.08-1.47; P = 0.003), non-chicken wing morphology (OR 5.82; 95% CI 1.61-21.03; P = 0.007), and LAA orifice diameter (OR 1.25; 95% CI 1.05-1.49; P = 0.014) were independent predictors of stroke after adjusting for all parameters that emerged as potential confounders with univariate analysis.
  
  
  CONCLUSIONS
  LAA analysis can potentially be used to inform guidance on the implication for stroke risk assessment.
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Kong
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: He
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Mei
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Wanli
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China.
authors.forename: Jiafen
authors.initials: J
authors.lastname: Liao
authors.affiliation: Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xing
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Cardiovascular Research Institute of Wuhan, University, Wuhan, Hubei 430060, China. Email: huanghe1977@hotmail.com.
authors.forename: He
authors.initials: H
authors.lastname: Huang
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000473:pathology*; D001281:Atrial Fibrillation / Q000503:physiopathology*; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology*