title: Left Atrial Geometry Improves Risk Prediction of Thromboembolic Events in Patients With Atrial Fibrillation.
abstract: Left atrial (LA) sphericity (LASP) is a new remodeling parameter based on LA shape analysis, with independent predictive value for recurrence after atrial fibrillation (AF) ablation.
  
  
  
  To evaluate the association between LASP and thromboembolic events (TE) in patients with AF.
  
  
  
  Twenty-nine AF patients and prior TE and 29 age- and gender-matched controls were included. LASP was calculated using a 3D-LA reconstruction. The LA appendage (LAA) volume and morphology were assessed. ROC curve analysis was performed for LASP, LA volume, LAA volume, and CHAD/CHA2 D-VASc scores (Stroke2 -the grouping variable-was excluded).
  
  
  
  Mean age of the study population was 61 ± 11 years (79.3% males, 53.4% hypertension, 8.6% diabetes). Patients with prior TE had higher LASP than those without (82.5 ± 3.3% vs. 80.2 ± 3.1%, P = 0.008); there were no differences in CHAD or CHA2 D-VASc scores, LA volume, LAA volume, or LAA morphology. The C-statistic was higher for LASP (0.71) than for other tested variables (CHAD score = 0.58, CHA2 D-VASc score = 0.59, LA volume = 0.50, LAA volume = 0.46; P < 0.01 for all vs. LASP). The best cutoff value for LASP was 83.6% (sensitivity 0.52, specificity 0.90). Logistic regression analysis showed predictive value for LASP (OR 1.26 per each 1% increase [1.85-52.20], P = 0.013), but not for clinical risk scores. The addition of LASP to the CHAD and CHA2 D-VASc scores increased the predictive value over the risk scores alone (P = 0.004), and reclassified 45.5% of patients with CHAD = 0 (no anticoagulation indicated) to moderate-risk (anticoagulation indicated).
  
  
  
  LA sphericity is associated with prior TE in AF patients and improves the performance of the CHAD and CHA2 D-VASc scores alone.
authors.affiliation: Heart Institute - Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Bisbal
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Gómez-Pulido
authors.affiliation: Cardiology Department-Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cabanas-Grandío
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington, USA.
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Susanna
authors.initials: S
authors.lastname: Prat-González
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Rosario J
authors.initials: RJ
authors.lastname: Perea
authors.affiliation: Heart Institute - Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
authors.forename: Roger
authors.initials: R
authors.lastname: Villuendas
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: Heart Institute - Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayés-Genís
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Comprehensive Arrhythmia Research and Management (CARMA) Center - University of Utah, Salt Lake City, Utah, USA.
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.affiliation: Atrial Fibrillation Unit (UFA) - Hospital Clínic, Barcelona, Spain.|Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D000368:Aged; D019540:Area Under Curve; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D001777:Blood Coagulation; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D014589:Utah
keywords: atrial fibrillation; catheter ablation; left atrial remodeling; sphericity; stroke; thromboembolism