Prediction of stroke in patients with severe aortic stenosis by left atrial appendage filling defect patterns on early and late-phase computed tomography

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-02-01 DOI:10.1016/j.ijcha.2024.101576

Pietro G. Lacaita , Sven Bleckwenn , Fabian Barbieri , Yannick Scharll , Johannes Deeg , Nikolaos Bonaros , Gerlig Widmann , Gudrun M. Feuchtner

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引用次数: 0

Abstract

Background

Stroke is a feared complication after TAVI. The objective was to assess whether left atrial appendage (LAA) filling-defect (FD) patterns from early and late-phase computed tomography (CT), predict stroke/TIA in patients with severe aortic stenosis.

Methods

124 patients with severe aortic stenosis (79.5y, 46.8% females) who underwent CT-Angiography for TAVI-planning were included (66.1% underwent TAVI, 18.6% surgical, 15.3% conservative treatment).CT-image-analysis included: CT-density (HU) from LAA tip-to-base and HU-gradients (I-III), the HU-ratio LAA/aorta, left-atrial-wall-thickness (LAWT) and the periatrial fat attenuation index (FAI).

Results

Stroke/TIA rate was 9.6 %. LAA-HU-gradient was slightly higher in non-stroke patients (p = 0.087). Persisting FDs during the late-phase were associated with stroke (p = 0.047) but not early-phase FDs. Early-phase FDs with HU < 245 (n = 15) were correlated with stroke (p = 0.05). A LAA-HU-gradient > 10HU had 91 % sensitivity and 68 % specificity for prediction of stroke. LAA-HU gradient I had a moderate accuracy (c = 0.592; 95 %CI:0.472–0.711; p = 0.317) for discrimination of stroke during the early phase, which enhanced during the late phase (c = 0.686;95 %CI:0.503–0.868; p = 0.046). Patients with stroke had a higher rate of FDs with HU-progression from early to late phase (>10HU)(p = 0.013), while the ratios LAA/aorta, LAWT, and periatrial-FAI were not different. Among clinical parameters, only age predicted stroke but not CHA2DS2-VASc-score. In multivariate analysis, late-phase FDs (p = 0.059)(OR 5.66: 95 %CI:0.936–34.28) but not early-phase FD were associated with stroke, and none of the major conventional risk factors.

Conclusion

Persisting LAA-filling defects on CT during the late-phase, and early-phase FD with <245HU predict stroke, and a CT-density progression >10HU from early-to-late phase. LAA-FD may improve stroke risk stratification.

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早期和晚期计算机断层左心耳充盈缺损模式预测严重主动脉瓣狭窄患者脑卒中。

背景：脑卒中是TAVI术后最可怕的并发症。目的是评估早期和晚期计算机断层扫描（CT）的左心耳（LAA）充盈缺损（FD）模式是否能预测严重主动脉瓣狭窄患者的卒中/TIA。方法：124例重度主动脉瓣狭窄患者（79.5例，女性46.8%）行ct血管造影行TAVI计划（66.1%行TAVI， 18.6%行手术，15.3%行保守治疗）。ct图像分析包括：LAA尖端到基底的ct密度（HU）和HU梯度（I-III）， LAA/主动脉的HU比，左房壁厚度（LAWT）和房周脂肪衰减指数（FAI）。结果：卒中/TIA发生率为9.6%。非脑卒中患者laa - hu梯度略高（p = 0.087）。晚期持续FDs与卒中相关（p = 0.047），但与早期FDs无关。早期FDs伴hu10hu预测脑卒中的敏感性为91%，特异性为68%。LAA-HU梯度I具有中等精度(c = 0.592；95%置信区间:0.472—-0.711;p = 0.317)对早期脑卒中的辨别力显著增强(c = 0.686; 95% CI:0.503-0.868；p = 0.046)。脑卒中患者早期至晚期hu进展的FDs发生率更高（bbb10hu）（p = 0.013），而LAA/主动脉、LAWT和围壁fai的比值无差异。在临床参数中，只有年龄能预测脑卒中，而cha2ds2 - vasc评分不能预测脑卒中。在多变量分析中，晚期FD (p = 0.059)（OR 5.66: 95% CI:0.936-34.28）与卒中相关，而早期FD与卒中无关，无主要常规危险因素。结论：CT表现为晚期持续存在laa充盈缺陷，早期FD表现为10HU，从早期到晚期持续存在。LAA-FD可改善脑卒中风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.