Introduction

In previous studies the risk of stroke recurrence has been associated with the left atrial appendage (LAA) morphology (non-chicken wing (NCW)), knowing those with a greater risk as malignant LAA. Recently, a simpler morphological classification has been suggested with two categories: Low-risk (LAA-L) and High-risk (LAA-H); which could be easier to apply and may correlate better with the risk of embolic stroke.

Methods

Retrospective analysis from a registry of patients with recurrent cardioembolic strokes despite appropriate anticoagulant therapy, in which LAA morphology was studied with cardiac CT scan. LAA morphology was classified according to the four current categories and H-L morphology by the same cardiologist. Other variables associated with a high risk of stroke were also assessed, such as CHA₂DS₂-VASc score and left atrial (LA) size.

Results

Twenty-six cases were included in the analysis. We identified 22 (84.6%) chicken wing (CW), 1 (3.8%) windsock and 3 (11.5%) cactus by the current classification system, while 15 (57.7%) were classified as LAA-H and 11 (42.3%) as LAA-L by the new system. Half of the 22 cases with CW morphology were considered LAA-H, whereas all NCW were also classified as LAA-H. LA diameter and area were significantly higher in cases with LAA-H morphology (p=0.03 and 0.014), and also in those CW and LAA-H, compared to those CW with LAA-L (p=0.035).

Conclusions

With this new classification system more than half of the cases of our malignant LAAs were classified as high-risk morphology. This morphology was also associated with an increased LA size.

中文翻译：

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恶性左心耳形态：当前分类与HL系统

介绍

在先前的研究中，中风复发的风险与左心耳（LAA）形态（非鸡翅（NCW））有关，已知那些人具有较高的恶性LAA风险。最近，已经提出了一种更简单的形态学分类，分为两个类别：低风险（LAA-L）和高风险（LAA-H）；这可能更易于应用，并且可能与栓塞性中风的风险更好地相关。

方法

尽管有适当的抗凝治疗，但对复发性心脏栓塞性卒中患者的登记进行回顾性分析，其中通过心脏CT扫描研究了LAA形态。同一位心脏病专家根据当前的四个类别和HL形态对LAA形态进行了分类。还评估了与中风高风险相关的其他变量，例如CHA ₂ DS ₂ -VASc得分和左心房（LA）大小。

结果

分析中包括26例。根据目前的分类系统，我们确定了22（84.6％）鸡翅（CW），1（3.8％）风向袋和3（11.5％）仙人掌，而15（57.7％）被归为LAA-H和11（42.3％）就像新系统的LAA-L。在22例具有CW形态的病例中，有一半被认为是LAA-H，而所有NCW也被归类为LAA-H。与具有LAA-L的CW（p = 0.035）相比，具有LAA-H形态的患者（p = 0.03和0.014），以及那些CW和LAA-H的LA直径和面积明显更高。

结论

通过这种新的分类系统，我们一半以上的恶性LAA病例被归类为高危形态。这种形态还与增加的LA大小有关。