Abstract 15625: Left Atrial Appendage Volumetric and Functional Assessment Using Cardiac CT-Derived Three-Dimensional Models

Introduction: The left atrial appendage (LAA) is the most common site of thrombus formation in atrial fibrillation (AF) patients who develop strokes, yet its dynamic volumetric parameters remain uncharacterized. We present a quantitative analysis of cardiac phase-specific LAA volumes and function using cardiac CT-derived three-dimensional (3D) models of 920 LAA segmentations.

Methods: We measured LAA volumes at 10% increments of the cardiac cycle (R-R interval) in patients with AF and controls with sinus rhythm (SR). After identifying the LAA orifice using anatomical landmarks on multiplanar CT images, we performed computational LAA segmentation using specialized software. For precise mapping, we used iterative active region-growing and cutting tools to separate the LAA from surrounding structures. We used the resulting 3D model for volumetric assessment of the LAA during the cardiac cycle.

Results: We analysed 580 LAA segmentations in patients with AF and 340 segmentations in patients with SR. Both groups displayed LAA volume increase from 0 to 40% of the cardiac cycle followed by a gradual decrease during diastole. LAA volumes were significantly higher in AF at 0%, 10%, 70%, 80%, and 90% of the cardiac cycle (p =0.01, 0.021, 0.047, 0.025 and 0.011, respectively). LAA volumetric variance within the AF group was significantly greater (p<0.001). LAA ejection fraction was significantly lower in AF compared to SR (40.8±16.1% vs 49.7±12.6%, p=0.003). Polynomial plots of incremental volume changes showed an accelerated rate of LAA filling in early systole in the SR, which was significantly dampened in AF.

Conclusions: We present the first comparative analysis of LAA volumetric and functional assessment in patients with AF and SR. We conclude that impaired LAA filling and emptying in AF can contribute to blood stasis and thrombogenicity. Further investigations into the utility of LAA metrics as prognostic and risk-stratification tools in patients with AF are warranted.