Correlation Analysis of Left Atrial Appendage Morphology and Function with Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation

Objective: The aim of this study is to analyze the correlations between left atrial appendage (LAA) morphology, LAA function, and other clinical factors with ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Methods: This single-center prospective observational study enrolled consecutive NVAF patients who underwent contrast-enhanced left atrial CT at the Department of Cardiology, Jiangning Hospital Affiliated to Nanjing Medical University from July 2021 to August 2022. Clinical and imaging data were collected at baseline. Survivors were followed annually for a minimum of two years, including repeat cranial CT. Patients were divided into two groups: those without new ischemic stroke during follow-up (Group A) and those with new ischemic stroke (Group B). Receiver operating characteristic (ROC) analysis was utilized to assess the predictive performance of the CHA2DS2-VASc score alone and in combination with LAA depth and LAA slow blood flow for new ischemic stroke; results are reported as area under the ROC curve (AUC). Results: A total of 100 patients completed the study, with 85 in Group A and 15 in Group B. Group B had significantly higher CHA2DS2-VASc scores, prevalence of hypertension history, statin use, LAA depth, left superior pulmonary vein long diameter, left superior pulmonary vein short diameter, incidence of left atrial thrombus, and LAA slow blood flow (all P < 0.05). Multivariable logistic regression identified hypertension history (OR = 1.092; 95% CI, 1.003–1.188; P = 0.042), LAA depth (OR = 27.923; 95% CI, 1.807–431.513; P = 0.017), and LAA slow blood flow (OR = 5.917; 95% CI, 1.349–25.952; P = 0.018) as independent risk factors for ischemic stroke during follow-up. The AUCs for predicting new ischemic stroke were 0.713 for the CHA2DS2-VASc score alone and 0.825 for the CHA2DS2-VASc score combined with LAA depth and LAA slow blood flow. Conclusion: In patients with NVAF, the risk of ischemic stroke is significant. Furthermore, integrating LAA depth and LAA slow-flow parameters with the CHA2DS2-VASc score substantially enhances its predictive ability for stroke compared to the CHA2DS2-VASc score alone.