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Statistical shape analysis of the left atrial appendage predicts stroke in atrial fibrillation

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Abstract

The shape of the left atrium (LA) and left atrial appendage (LAA) have been shown to predict stroke in patients with atrial fibrillation (AF). Prior studies rely on qualitative assessment of shape, which limits reproducibility and clinical utility. Statistical shape analysis (SSA) allows for quantitative assessment of shape. We use this method to assess the shape of the LA and LAA and predict stroke in patients with AF. From a database of AF patients who had previously undergone MRI of the LA, we identified 43 patients with AF who subsequently had an ischemic stroke. We also identified a cohort of 201 controls with AF who did not have a stroke after the MRI. We performed SSA of the LA and LAA shape to quantify the shape of these structures. We found three of the candidate LAA shape parameters to be predictive of stroke, while none of the LA shape parameters predicted stroke. When the three predictive LAA shape parameters were added to a logistic regression model that included the CHA2DS2-VASc score, the area under the ROC curve increased from 0.640 to 0.778 (p = .003). The shape of the LA and LAA can be assessed quantitatively using SSA. LAA shape predicts stroke in AF patients, while LA shape does not. Additionally, LAA shape predicts stroke independent of CHA2DS2-VASc score. SSA for assessment of LAA shape may improve stroke risk stratification and clinical decision making for AF patients.

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Data Availability

The datasets analyzed in this study are available from the corresponding author on reasonable request.

Abbreviations

LA:

Left atrium

LAA:

Left atrial appendage

AF:

Atrial fibrillation

SSA:

Statistical shape analysis

MRI:

Magnetic resonance imaging

PCA:

Principle component analysis

CT:

Computed tomography

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Acknowledgements

We would like to thank everyone at the Comprehensive Arrhythmia Research and Management (CARMA) Center who helped with image segmentation and chart review.

Funding

Funding for this study was provided by the NIH (R01-HL135568). Additional funding was provided by Comprehensive Arrhythmia Research and Management Center and the Scientific Computing and Imaging Institute at the University of Utah.

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Authors and Affiliations

  1. Division of Cardiology, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA

    Erik T. Bieging & Lowell Chang

  2. Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA

    Alan Morris

  3. Section of Cardiology, Tulane University Heart & Vascular Institute, New Orleans, LA, USA

    Lilas Dagher & Nassir F. Marrouche

  4. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA

    Lowell Chang & Joshua Cates

Authors
  1. Erik T. Bieging
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  2. Alan Morris
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  3. Lowell Chang
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  4. Lilas Dagher
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  5. Nassir F. Marrouche
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  6. Joshua Cates
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Contributions

EB contributed to the conception and design of the study, data analysis and interpretation, and drafted the manuscript. AM contributed to the conception and design of the study, data acquisition, analysis and interpretation, and substantively revised and approved the manuscript. LC contributed to the conception and design of the study, and substantively revised and approved the manuscript. LD contributed to data interpretation and substantively revised and approved the manuscript. NM contributed to the conception and design of the study, data interpretation, and substantively revised and approved the manuscript. JC contributed to the conception and design of the study, data analysis and interpretation, and substantively revised and approved the manuscript.

Corresponding author

Correspondence to Erik T. Bieging.

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Conflict of interest

Dr. Bieging has nothing to disclose. Mr. Morris discloses a equity interest in MARREK, Inc. Dr. Chang has nothing to disclose. Dr. Marrouche reports receiving grant support and consulting fees from Abbott, Medtronic, Biosense Webster, Boston Scientific, GE Health Care, and Siemens, receiving consulting fees from Preventice, and holding equity in Marrek and Cardiac Designs. Dr. Cates discloses a small minority interest of shares in MARREK, Inc.

Ethical approval

The study was approved by the University of Utah Institutional Review Board with a waiver of consent.

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Bieging, E.T., Morris, A., Chang, L. et al. Statistical shape analysis of the left atrial appendage predicts stroke in atrial fibrillation. Int J Cardiovasc Imaging 37, 2521–2527 (2021). https://doi.org/10.1007/s10554-021-02262-8

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  • DOI: https://doi.org/10.1007/s10554-021-02262-8

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