We aimed to correlate left atrial appendage (LAA) structure and function with the
history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation
(AF). We analyzed the data of 649 patients with AF who were scheduled for catheter
ablation. Patients underwent cardiac computed tomography and transesophageal echocardiography
before ablation. The LAA morphologies depicted by cardiac computed tomography were
categorized into 4 groups: cauliflower, chicken wing, swan, and windsock shapes. The
mean age was 61.3 ± 10.5 years, 33.9% were women. The prevalence of stroke/TIA was
7.1%. After adjustment for the main risk factors, the LAA flow velocity ≤35.3 cm/s
(odds ratio [OR] 2.18, 95% confidence interval [CI] 1.09 to 4.61, p = 0.033) and the
swan LAA shape (OR 2.69, 95% CI 0.96 to 6.86, p = 0.047) independently associated
with a higher risk of stroke/TIA, whereas the windsock LAA morphology proved to be
protective (OR 0.32, 95% CI 0.12 to 0.77, p = 0.017) compared with the cauliflower
LAA shape. Comparing the differences between the LAA morphology groups, we measured
a significantly smaller LAA orifice area (389.3 ± 137.7 mm2 in windsock vs 428.3 ±
158.9 ml in cauliflower, p = 0.021) and LAA volume (7.4 ± 3.0 mm2 in windsock vs 8.5
± 4.8 mm2 in cauliflower, p = 0.012) in patients with windsock LAA morphology, whereas
the LAA flow velocity did not differ significantly. Reduced LAA function and swan
LAA morphology were independently associated with a higher prevalence of stroke/TIA,
whereas the windsock LAA shape proved to be protective. Comparing the differences
between the various LAA morphology types, significantly lower LAA volume and LAA orifice
area were measured in the windsock LAA shape than in the cauliflower LAA shape.
