Left Atrial Appendage Volume Increased in More Than Half of Patients with Cryptogenic Stroke
Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether incr...
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Published in | PloS one Vol. 8; no. 11; p. e79519 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Public Library of Science
04.11.2013
Public Library of Science (PLoS) |
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Online Access | Get full text |
ISSN | 1932-6203 1932-6203 |
DOI | 10.1371/journal.pone.0079519 |
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Abstract | Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients.
This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices.
In control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA.
LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. |
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AbstractList | Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. Methods This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. Results In control subjects, mean LAA volume was 3.4±1.1 mL/m.sup.2 . Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m.sup.2 . In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m.sup.2 vs. 3.4±1.1 mL/m.sup.2 ; P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. Conclusion LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. In control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. In control subjects, mean LAA volume was 3.4±1.1 mL/m.sup.2 . Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m.sup.2 . In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m.sup.2 vs. 3.4±1.1 mL/m.sup.2 ; P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. BACKGROUND: Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. METHODS: This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. RESULTS: In control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. CONCLUSION: LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients.BACKGROUNDIschemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients.This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices.METHODSThis study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices.In control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA.RESULTSIn control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA.LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation.CONCLUSIONLAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30–40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. Methods This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. Results In control subjects, mean LAA volume was 3.4±1.1 mL/m 2 . Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m 2 . In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m 2 vs. 3.4±1.1 mL/m 2 ; P <0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. Conclusion LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30–40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. Methods This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. Results In control subjects, mean LAA volume was 3.4±1.1 mL/m2. Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m2. In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m2 vs. 3.4±1.1 mL/m2; P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. Conclusion LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation. |
Audience | Academic |
Author | Tapiola, Tero Kärkkäinen, Satu Taina, Mikko Jäkälä, Pekka Vanninen, Ritva Sipola, Petri Hedman, Marja |
AuthorAffiliation | 3 Heart Center, Kuopio University Hospital, Kuopio, Finland 6 Department of Neurology, North Kymi Hospital, Kouvola, Finland 1 Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland 4 NeuroCenter, Kuopio University Hospital, Kuopio, Finland The University of Chicago, United States of America 2 Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland 5 Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland |
AuthorAffiliation_xml | – name: 6 Department of Neurology, North Kymi Hospital, Kouvola, Finland – name: 2 Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland – name: The University of Chicago, United States of America – name: 5 Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland – name: 1 Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland – name: 3 Heart Center, Kuopio University Hospital, Kuopio, Finland – name: 4 NeuroCenter, Kuopio University Hospital, Kuopio, Finland |
Author_xml | – sequence: 1 givenname: Mikko surname: Taina fullname: Taina, Mikko – sequence: 2 givenname: Ritva surname: Vanninen fullname: Vanninen, Ritva – sequence: 3 givenname: Marja surname: Hedman fullname: Hedman, Marja – sequence: 4 givenname: Pekka surname: Jäkälä fullname: Jäkälä, Pekka – sequence: 5 givenname: Satu surname: Kärkkäinen fullname: Kärkkäinen, Satu – sequence: 6 givenname: Tero surname: Tapiola fullname: Tapiola, Tero – sequence: 7 givenname: Petri surname: Sipola fullname: Sipola, Petri |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24223960$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3389_fcvm_2022_968630 crossref_primary_10_1016_j_jstrokecerebrovasdis_2019_05_008 crossref_primary_10_18821_0023_2149_2018_96_5_389_396 crossref_primary_10_1056_NEJMcp1503946 crossref_primary_10_1371_journal_pone_0090903 crossref_primary_10_3390_jcm12206491 crossref_primary_10_1161_JAHA_123_030147 crossref_primary_10_1371_journal_pone_0120598 crossref_primary_10_1007_s10237_021_01454_4 crossref_primary_10_1093_europace_euz212 crossref_primary_10_1155_2022_9125224 crossref_primary_10_1371_journal_pone_0120910 crossref_primary_10_1007_s00380_018_1119_3 crossref_primary_10_1016_j_hrthm_2015_12_026 crossref_primary_10_1016_j_compbiomed_2022_105897 crossref_primary_10_4329_wjr_v15_i4_98 crossref_primary_10_1007_s10554_022_02779_6 crossref_primary_10_36660_abc_20190492 crossref_primary_10_1371_journal_pone_0101580 crossref_primary_10_1161_STROKEAHA_113_003720 crossref_primary_10_1371_journal_pone_0118822 crossref_primary_10_1371_journal_pone_0173703 crossref_primary_10_3389_fcvm_2021_753949 |
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DocumentTitleAlternate | Enlarged Atrial Appendage in Cryptogenic Stroke |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Conceived and designed the experiments: MT RV MH PJ PS. Performed the experiments: MT RV MH PJ PS. Analyzed the data: MT RV MH PJ SK TT PS. Contributed reagents/materials/analysis tools: MT RV MH PJ SK TT PS. Wrote the manuscript: MT RV MH PJ SK TT PS. Competing Interests: The authors have declared that no competing interests exist. |
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Snippet | Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage... Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial... Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30–40% of strokes in stroke registries. The left atrial... BACKGROUND: Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left... Background Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30–40% of strokes in stroke registries. The left atrial... |
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SubjectTerms | Age Atherosclerosis Atrial Appendage - diagnostic imaging Atrial Appendage - pathology Cardiac arrhythmia Cardiovascular disease Cardiovascular diseases Cardiovascular system Case-Control Studies CAT scans Clinical medicine Computed tomography Contrast agents Development and progression Echocardiography EKG Electrocardiography Embolism Embolisms Etiology Female Fibrillation Flow velocity Health risks Heart Heart diseases Hospitals Humans Ischemia Male Males Medical imaging Medical research Medicine Middle Aged Neurology Organ Size Pathogenesis Patients Radiology Reproducibility of Results Risk factors Statistics Stroke Stroke - diagnostic imaging Stroke - pathology Stroke patients Surface area Thromboembolism Thrombosis Tomography, X-Ray Computed Ultrasonic imaging |
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Title | Left Atrial Appendage Volume Increased in More Than Half of Patients with Cryptogenic Stroke |
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