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The cause of cryptogenic stroke is unknown. Even long term rhythm monitoring has failed to reveal atrial fibrillation.We hypothesized that complex left atrial appendage morphology is independent risk factor for cryptogenic stroke.
This is a single-center, retrospective case control study of patients with and without stroke who were imaged by 2D-TEE from 2009 to 2016. A total of 114 patients were enrolled. Patients with mitral stenosis, artificial heart valves, or poor image quality were excluded. Left Atrial Appendage morphology, SLA2M vs CLA2M, was independently characterized by a pair of Cardiologists blinded to the etiology. ( Image) Stroke etiology was determined using the causative classification system by a vascular neurologist.
Of the 97 subjects meeting study criteria, 45 (46.4%) had CLA2M. In multivariable regression, CLA2M significantly increased the odds of cryptogenic stroke (OR 5.00, 95%CI 1.05-23.73, p=0.043) even adjusting for age and CHADVASC score.
CLA2M is associated with increased risk of cryptogenic strokes indicating that complex LAA morphology may be a nidus for generating thrombus and thus increased stroke risk. Further studies are indicated to understand the complex relation between CLA2M and cryptogenic stroke without atrial fibrillation. Newer therapeutic modalities like LAA closure may become relevant to treat in such cases.