Yonsei Med J.  2014 Nov;55(6):1516-1525. 10.3349/ymj.2014.55.6.1516.

Characteristics of Pulmonary Vein Enlargement in Non-Valvular Atrial Fibrillation Patients with Stroke

• Lee JM
• Kim JY
• Shim J
• Uhm JS
• Kim YJ
• Lee HJ
• Pak HN
• Lee MH
• Joung B

• KMID: 2070198
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1516

Abstract

PURPOSE
The association between pulmonary vein (PV) dilatation and stroke in non-valvular atrial fibrillation (AF) patients remains unknown.
MATERIALS AND METHODS
We examined the left atrium (LA) and PV in control (n=138) and non-valvular AF patients without (AF group, n=138) and with non-hemorrhagic stroke (AF with stroke group, n=138) using computed tomography.
RESULTS
The LA, LA appendage (LAA), and all PVs were larger in the AF than control patients. The orifice areas of the LAA (5.6+/-2.2 cm2 vs. 4.7+/-1.7 cm2, p<0.001), left superior PV (3.8+/-1.5 cm2 vs. 3.4+/-1.2 cm2, p=0.019), and inferior PV (2.3+/-1.0 cm2 vs. 1.8+/-0.7 cm2, p<0.001) were larger in the AF with stroke than in the AF only group. However, right PVs were not different between the two groups. In a multivariate analysis, the orifice areas of the left superior PV [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.03-1.51, p=0.02], left inferior PV (OR 1.97, 95% CI 1.41-2.75, p<0.001), and LAA (OR 1.30, 95% CI 1.13-1.50, p<0.001) were independent predictors of stroke.
CONCLUSION
Compared to the right PVs, the left PVs and LAA exhibited more significant enlargement in patients with AF and stroke than in patients with AF only. This finding suggests that the remodeling of left-sided LA structures might be related to stroke.

Keyword

Atrial fibrillation; stroke; pulmonary veins; atrial appendage; multidetector computed tomography

MeSH Terms

Aged
Atrial Appendage/physiopathology/*radiography
Atrial Fibrillation/*complications/diagnosis/physiopathology
Atrial Function, Right/*physiology
Female
Heart Atria
Humans
Male
Middle Aged
Multidetector Computed Tomography/*methods
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prognosis
Pulmonary Veins/physiopathology/*radiography
Stroke/diagnosis/*etiology
Tomography, X-Ray Computed/methods

Figure

• 

  Fig. 1 Multiplanar reconstructed (MPR) images illustrating the double-oblique measurements of pulmonary veins (PVs) and left atrial appendage (LAA) ostial diameters. (A) 3D reconstruction image of left atrium and pulmonary veins. The dotted line denotes right superior PV ostium. (B) Oblique MPR view of the right superior PV. The ostium (dotted line) was confirmed in multiple views. (C) Enlarged axial MPR view across the ostium of the superior PV showing measurements of the PV diameter (black arrows). (D) 3D reconstruction image of LAA. (E and F) MPR view of the LAA showing enlarged LAA. 3D, three-dimensional.

• 

  Fig. 2 Comparison of LA volume (A) and orifice area of the LAA and PVs (B) between the three patient groups. LA, left atrium; LAA, left atrial appendage; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.

• 

  Fig. 3 ROC curve analysis. The LAA orifice area, LA volume, LIPV orifice area, and LSPV orifice area predicted stroke in AF patients with area under the curves (AUCs) of 0.739, 0.720, 0.674, and 0.587, respectively. ROC, receiver operating characteristic; LAA, left atrial appendage; LA, left atrium; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.

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