Regional function analysis of left atrial appendage using motion estimation CT and risk of stroke in patients with atrial fibrillation.
OBJECTIVE
The aim of this article is to determine the association between left atrial appendage (LAA) regional dysfunction using image-based motion-estimation computed tomography (CT) (iME) and a prior history of stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF).


RESULTS
In this single-centre retrospective case-control study, among patients referred for AF ablation who underwent pre-ablation cardiac CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA at the time of CT scan and 18 age- and gender-matched controls. All the patients were in sinus rhythm at the time of CT scan. Four-dimensional motion vector field was estimated from the CT images using iME. To assess myocardial deformation, area change ratio (A) and area change rate (AR) were calculated over the endocardial surface of the LAA. There was no significant difference in the baseline patient characteristics between the stroke/TIA group and the control group (67.6 ± 8.1 years old, 66.7% male, 16.7% persistent AF). LAA maximum (Amax; 23.8 ± 33.0 vs. 52.9 ± 41.2%, P = 0.02) and pre-atrial contraction area change ratio (ApreA; 13.7 ± 17.7 vs. 30.9 ± 29.2%, P = 0.04) were significantly lower in the stroke/TIA group than in the control group, respectively. The difference in LAA Amax and ApreA remained significant in multivariate analysis (P = 0.03 and P = 0.04, respectively).


CONCLUSIONS
LAA regional dysfunction is associated with stroke/TIA in AF patients. Our results offer a basis for a prospective study to determine the role of LAA regional dysfunction by iME in predicting cerebrovascular events such as stroke or TIA.
Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
Abdullah
A
Al-Issa
Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
Yuko
Y
Inoue
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jochen
J
Cammin
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Qiulin
Q
Tang
Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
Saman
S
Nazarian
Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA.
Hugh
H
Calkins
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Elliot K
EK
Fishman
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Katsuyuki
K
Taguchi
Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA hashika1@jhmi.edu.
Hiroshi
H
Ashikaga
D000368:Aged; D000704:Analysis of Variance; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000601:surgery; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods; D016208:Databases, Factual; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome
Atrial fibrillation; Cardiac function; Computed tomography; Left atrial appendage; Stroke; Transient ischaemic attack