Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation

Jung Myung Lee, Jaemin Shim, Jae Sun Uhm, Young Jin Kim, Hye Jeong Lee, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

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86 Citations (Scopus)


The structural and functional characteristics of left atrial appendage (LAA) in patients with atrial fibrillation (AF) with previous stroke remain incompletely elucidated. This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p <0.001), larger LAA orifice area (4.5 ± 1.5 vs 3.0 ± 1.1 cm2, p <0.001), and slower LAA flow velocity (36 ± 19 vs 55 ± 20 cm/s, p <0.001). LAA flow velocity was negatively correlated with LAA orifice size (R = -0.48, p <0.001). After adjustment for multiple potential confounding factors including CHA2DS2-VASc score, persistent AF, and LA dimension, large LAA orifice area (odds ratio 6.16, 95% confidence interval 2.67 to 14.18, p <0.001) and slow LAA velocity (odds ratio 3.59, 95% confidence interval 1.42 to 9.08, p = 0.007) were found to be significant risk factors of stroke. In patients with LAA flow velocity <37.0 cm/s, patients with large LAA orifice (>3.5 cm2) had greater incidence of stroke than those with LAA orifice of ≤3.5 cm2 (75% vs 23%, p <0.001). In conclusion, LAA orifice enlargement was related to stroke risk in patients with nonvalvular AF even after adjustment for other risk factors, and it could be the cause of decreased flow velocity in LAA.

Original languageEnglish
Pages (from-to)963-969
Number of pages7
JournalAmerican Journal of Cardiology
Issue number6
Publication statusPublished - 2014 Mar 15

Bibliographical note

Funding Information:
This study was supported in part by research grants of the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Science and Technology ( 2012-0007604 , 2012-045367 ), and a grant of the Korean Healthcare technology R&D project, Ministry of Health & Welfare ( A121668 ). No other potential conflicts of interest relating to this article were reported.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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