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Objective <p>Thrombus formation in atrial fibrillation is caused by blood flow stagnation within the left atrial appendage (LAA). It is believed that blood flow tends to stagnate within the LAA even in patients with sinus rhythm and high risk of stroke. This study evaluated blood flow within the LAA using four-dimensional flow magnetic resonance imaging among patients stratified by the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA<sub>2</sub>DS<sub>2</sub>-VASc) score.</p> Methods <p>Ninety-eight participants with sinus rhythm (70 patients, 28 controls) underwent non-contrast four-dimensional flow magnetic resonance imaging. Participants were divided into low- and high-risk groups (CHA<sub>2</sub>DS<sub>2</sub>-VASc scores 0–2 and 3–9, respectively. Blood flow parameters, including the blood flow volume in the basal, middle, and top segments of the LAA, were analyzed and compared between groups.</p> Results <p>The blood flow volume was significantly reduced in the top segment of the LAA in the high-risk group (low-risk: 3.13 ± 1.07&#xa0;mL/cm<sup>2</sup> vs. high-risk: 2.54 ± 0.96&#xa0;mL/cm<sup>2</sup>, p = 0.006). However, the blood flow volume in the basal and middle segments did not differ significantly between the two groups (basal segment, p = 0.14; middle segment, p = 0.44). In addition, larger LAA volumes (EDV, ESV, and mean volume) were associated with reduced top-segment flow, but correlations with intra-LAA flow were not statistically significant.</p> Conclusions <p>In patients with high CHA<sub>2</sub>DS<sub>2</sub>-VASc scores, blood flow stagnation can occur in the LAA top segment even in the presence of sinus rhythm. Establishing blood flow-based criteria may enhance the potential applications of LAA closure to prevent stroke.</p>

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Left atrial appendage blood flow analysis using four-dimensional flow magnetic resonance imaging

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Akihito Ohkawa,
  • Tomohiro Nakajima,
  • Shingo Tsushima,
  • Itaru Hosaka,
  • Ayaka Arihara,
  • Naomi Yasuda,
  • Tsuyoshi Shibata,
  • Junji Nakazawa,
  • Kazutoshi Tachibana,
  • Mitsuhiro Nakanishi,
  • Yutaka Iba,
  • Nobuyoshi Kawaharada

摘要

Objective

Thrombus formation in atrial fibrillation is caused by blood flow stagnation within the left atrial appendage (LAA). It is believed that blood flow tends to stagnate within the LAA even in patients with sinus rhythm and high risk of stroke. This study evaluated blood flow within the LAA using four-dimensional flow magnetic resonance imaging among patients stratified by the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA2DS2-VASc) score.

Methods

Ninety-eight participants with sinus rhythm (70 patients, 28 controls) underwent non-contrast four-dimensional flow magnetic resonance imaging. Participants were divided into low- and high-risk groups (CHA2DS2-VASc scores 0–2 and 3–9, respectively. Blood flow parameters, including the blood flow volume in the basal, middle, and top segments of the LAA, were analyzed and compared between groups.

Results

The blood flow volume was significantly reduced in the top segment of the LAA in the high-risk group (low-risk: 3.13 ± 1.07 mL/cm2 vs. high-risk: 2.54 ± 0.96 mL/cm2, p = 0.006). However, the blood flow volume in the basal and middle segments did not differ significantly between the two groups (basal segment, p = 0.14; middle segment, p = 0.44). In addition, larger LAA volumes (EDV, ESV, and mean volume) were associated with reduced top-segment flow, but correlations with intra-LAA flow were not statistically significant.

Conclusions

In patients with high CHA2DS2-VASc scores, blood flow stagnation can occur in the LAA top segment even in the presence of sinus rhythm. Establishing blood flow-based criteria may enhance the potential applications of LAA closure to prevent stroke.