title: Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation: A meta-analysis.
abstract: Thromboembolic event (TE) risk stratification is performed by using CHA2DS2VASc score. It has been suggested that left atrial appendage (LAA) morphology independently influences TE risk in patients with nonvalvular atrial fibrillation. LAA morphology has been classified into 4 types: chicken wing, cauliflower, windsock, and cactus.
  
  
  
  The purpose of this study was to determine TE risk for each LAA morphology in patients with atrial fibrillation with low to intermediate TE risk.
  
  
  
  A systematic review of MEDLINE, Cochrane Library, and Embase for studies that used computed tomography, tridimensional transesophageal echocardiography, and cardiac magnetic resonance imaging to categorize the LAA morphologies with assessment of TE prevalence. Odds ratio (OR) and 95% confidence intervals (CIs) were measured using the Mantel-Haenszel method. The fixed effects model was used, and if heterogeneity (I2) was >25%, effects were analyzed using a random model.
  
  
  
  Eight studies with 2596 patients were included. Eighty-four percent (n=1872) of patients had a CHADS2 score of <2. TE risk was lower in chicken wing morphology than in non-chicken wing morphology (OR 0.46; 95% CI 0.36-0.58). Likewise, chicken wing morphology had lower TE risk than did other morphologies (chicken wing vs cauliflower: OR 0.38; 95% CI 0.26-0.56; chicken wing vs windsock: OR 0.48; 95% CI 0.31-0.73; chicken wing vs cactus: OR 0.49; 95% CI 0.36-0.66).
  
  
  
  Patients with chicken wing LAA morphology are less likely to develop TE than patients with non-chicken wing morphology. LAA morphology may be a valuable criterion in predicting TE and could affect the stratification and anticoagulation management of patients with low to intermediate TE risk.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Florentino
authors.initials: F
authors.lastname: Lupercio
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Juan
authors.initials: J
authors.lastname: Carlos Ruiz
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Berardi
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Faillace
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krumerman
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: John D
authors.initials: JD
authors.lastname: Fisher
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ferrick
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Mario
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiology, Stanford University, Palo Alto, California; Case Western Reserve University, Cleveland, Ohio; Scripps Clinic, San Diego, California; Dell Medical School, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy. Electronic address: dibbia@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000473:pathology; D001281:Atrial Fibrillation / Q000150:complications*; D057791:Cardiac Imaging Techniques / Q000379:methods*; D006801:Humans; D018570:Risk Assessment / Q000379:methods; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
keywords: Atrial fibrillation; Cardiac imaging; Cerebrovascular accident; Left atrial appendage morphology; Thromboembolic events