Left atrium incisure curvature: an indicator for predicting atrial fibrillation-related cardioembolism

The use of supplementary parameters, such as clinical criteria, biomarkers, and imaging data, may enhance the risk prediction of stroke and systemic embolic events. Current stroke risk scores are clinically practical but limited in their ability to predict stroke risk accurately in individual patients. It is difficult for doctors to distinguish patients with truly high-thrombotic risk. In this study, we propose a simple and effective method for predicting stroke and systemic embolic events in patients with atrial fibrillation (AF).

In this retrospective study, 169 patients with AF were divided into three groups: Group A (those with paroxysmal AF with no cardioembolic events), Group B (those with persistent AF with no cardioembolic events), and Group C (those with persistent AF with cardioembolic events). By examining the chest CT images of all the included patients, we discovered that the left atrium (LA) incisure disappearing with the progression of AF, particularly in those with cardioembolic events (Group C). For the convenience of quantitative analysis, a border detection algorithm along with an LA incisure curvature computation algorithm was developed to predict cardioembolic events in patients with AF.

The results indicated that the average curve rates of LA incisure were − 2.6 (-3.55, -1.95) ×10^− 3, -1.40 (-2.13, -0.43) ×10^− 3, and 0.51 (0.02, 1.40) ×10^− 3 for Groups A, B, and C, respectively. The accuracy, sensitivity, and specificity of the LA incisure curvature for predicting cardioembolic events were 85.21%, 96%, and 80.7%, respectively.

LA incisure curvature is an effective indicator for predicting AF-related strokes and systemic embolic events, which should be confirmed through multicentre retrospective and prospective research in the future.