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Morpho-functional analysis of the left atrium appendage for stroke risk assessment in atrial fibrillation

Session Poster session 3

Speaker Corrado Tomasi

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Mechanisms for Stroke in Atrial Fibrillation
  • Session type : Poster Session
  • FP Number : P1482

Authors : A Masci (Bologna,IT), L Barone (Bologna,IT), C Tomasi (Ravenna,IT), L Dede' (Milan,IT), A Quarteroni (Milan,IT), C Corsi (Bologna,IT)

Authors:
A Masci1 , L Barone1 , C Tomasi2 , L Dede'3 , A Quarteroni3 , C Corsi1 , 1University of Bologna, DEI - Bologna - Italy , 2Santa Maria delle Croci Hospital - Ravenna - Italy , 3Milan Polytechnic , MOX - Milan - Italy ,

Citation:

Atrial fibrillation (Afib) modifies blood circulation inside left atrium (LA) and left atrial appendage (LAA) promoting blood stasis and clot formation. LAA is the site with the highest blood stasis, and about 90% of the intracardiac thrombi originally develop in the LAA. Clinical risk scores do not include any direct measure of heamodynamic effect of Afib, and their resulting predictive power remains low. Computational fluid dynamics (CFD) has been demonstrated to be a valuable non-invasive tool to determine physical parameters in a complex fluid dynamics system, and its use on LA and LAA may improve cardioembolic risk stratification.

The aim of this study was development of a workflow to quantitatively define the influence of the LAA morphology on LA hemodynamics. Five 3D LA anatomical models characterized by the same LA chamber and different LAAs derived from real clinical data were created. These new anatomical models represented the computational domain for the computational fluid dynamics (CFD) simulations. The shape of the LAAs was geometrically characterized and correlated with blood velocity, vorticity, LAA orifice velocity, residence time resulting from the CFD analysis.

Results (see Figure) showed that not only complex morphologies were characterized by low velocities and  vorticity; even qualitatively simple morphologies showed a thrombogenic risk equal or higher than more complex LAAs. CFD results supported the hypothesis that LAA geometric characterization play a key-role in defining thromboembolic risk.

The proposed procedure might address the development of a tool for patient-specific cardioembolic risk assessment and preventive treatment in AF patients, relying on LAA morpho-functional characterization.



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