Table 4.
Structural biomarkers for stroke risk in AF.
| References | Design | Study population | n | % male; mean (SD) age, years | Relevant outcome measures | Follow-up duration | Biomarker | Findings |
|---|---|---|---|---|---|---|---|---|
| Dakay et al. (107) | Prospective cohort | AF hospitalized with ischemic stroke | 225 | 44.4; 79.5 (10.5) | Anticoagulation failure | NA | LAE | More severe left atrial enlargement was associated with greater risk of anticoagulation failure resulting in stroke |
| Hamatani et al. (108) | Prospective registry | AF | 2,713 | 60.2; 73.7 (NA) | Ischemic stroke or SE | 32.6 months | LAE | LA diameter >45 mm was associated with a 1.7-fold greater risk of ischemic stroke or SE |
| Kong et al. (109) | Prospective cohort | Drug-refractory AF undergoing catheter ablation | 219 | 65.3; 58.1 (NA) | Stroke | NA (retrospective) | LAA morphology | Non-chicken wing morphology was associated with 5.8-fold greater stroke risk |
| Khurram et al. (110) | Prospective cohort | AF referred for catheter ablation | 678 | 74.8; 59.5 (9.7) | Stroke or TIA | NA (retrospective) | LAA morphology | No association with stroke or TIA |
| LAA trabeculations | Extensive LAA trabeculation was associated with a greater stroke or TIA risk | |||||||
| LAA orifice diameter | Smaller LAA orifice was associated with a greater stroke or TIA risk | |||||||
| LAA length | Shorter LAA length was associated with a greater stroke or TIA risk | |||||||
| Kimura et al. (111) | Case-controlled study | Drug-refractory AF who underwent catheter ablation | 80 | 82.5; 58.6 (6.0) | Stroke | NA (retrospective) | LAA morphology | Cauliflower morphology was associated with a greater stroke risk |
| Di Biase et al. (112) | Prospective cohort | Drug-refractory AF undergoing catheter ablation | 932 | 79; 59 (10) | Ischemic stroke or TIA | NA (retrospective) | LAA morphology | Chicken wing morphology was associated with lowest risk of ischemic stroke or TIA; with chicken wing morphology as reference, cactus, windsock and cauliflower were associated with a 4.1-, 4.5-, and 8.0-fold greater risks of ischemic stroke or TIA, respectively |
| Beinart et al. (113) | Case-controlled study | Non-anticoagulated AF | 144 | 75; 54.5 (9.9) | Stroke or TIA | NA (retrospective) | LAA volume | No association with stroke or TIA |
| LAA depth | No association with stroke or TIA | |||||||
| LAA neck dimensions | High LAA neck dimension was associated with greater stroke or TIA risk | |||||||
| LAA number of lobes | No association with stroke or TIA | |||||||
| Goldman et al. (114) | Sub-study of prospective cohort | AF with at least 1 high-risk stroke factor* | 721 | 76; 68 (9) | Ischemic stroke or SE | NA | LAA peak antegrade flow velocity | LAA peak antegrade flow velocity <20 cm/s was associated with greater risk of Ischemic stroke or SE |
| Zabalgoitia et al. (115) | Sub-study of prospective cohort | AF with at least 1 high-risk stroke factor* | 786 | 76; 69 (9) | Ischemic stroke or SE | NA | LAA thrombus | Presence of LAA thrombus was associated with a 2.5-fold greater risk of Ischemic stroke or SE |
| SEC | Presence of SEC was associated with a 3.7-fold greater risk of Ischemic stroke or SE | |||||||
| LAA peak antegrade flow velocity | LAA peak antegrade flow velocity <20 cm/s was associated with a 1.7-fold greater risk of Ischemic stroke or SE | |||||||
| Complex aortic plaque | Presence of complex aortic plaque was associated with a 2.1-fold greater risk of Ischemic stroke or SE | |||||||
| Leung et al. (116) | Prospective cohort | AF undergoing TOE | 272 | 68; 68 (11) | Stroke or SE | 17.5 months | LA SEC | Presence of LA SEC was associated with a 3.5-fold greater risk of stroke or SE |
| SPAF (117) | Sub-study of RCT | AF | 568 | 70; 67 (12) | Ischemic stroke or SE | 1.3 years | 14 echocardiographic parameters | LV dysfunction and higher LA size were the associated with greater risk of Ischemic stroke or SE |
AF, atrial fibrillation; IQR, interquartile range; LA, left atrial; LAA, left atrial appendage; LAE, left atrial enlargement; LV, left ventricular; NA, not applicable or available; RCT, randomized controlled trial; SD, standard deviation; SE, systemic embolism; SEC, spontaneous echo contrast; TIA, transient ischemic attack; TOE, trans-esophageal echocardiography.
*
Similar study cohort.