The impact of left atrial morphology on thrombosis risk in atrial fibrillation

Abstract

Atrial fibrillation (AF) is an arrhythmia disease that can disrupt the movement of the left atrium (LA), which will facilitate thromboembolism in LA and further exacerbate the stroke risk. The left atrial appendage (LAA) is a vital site for thrombus formation. The morphology of the LAA is believed to have a profound effect on thrombosis. However, due to the limitation of observation and monitoring methods, the mechanism of this effect is still unrevealed. Virchow's triad is a theory of thrombogenic mechanisms, stating that endothelial injury, blood hypercoagulability, and blood stasis are the three main factors involved in thrombus formation. In this study, we conducted personalized simulation analyses for 12 AF patients and discussed simulation results from the perspective of Virchow's triad. The simulation results indicate the effectiveness of Virchow's triad in elucidating the thrombosis mechanism within the LAA. The LAA is more prone to thrombosis than the other region of LA, because of the lower blood flow velocity and significantly higher endothelial cell activation potential values there, which indicates a higher risk of blood stasis and endothelial injury, respectively. Furthermore, a comprehensive score is proposed to assess the performance of Virchow's triad in the LAA. The morphology of LA has a significant influence on the performance of the three factors in Virchow's triad. Hence, for a quickly assessment of LAA thrombosis risk in AF patients through the lens of Virchow's triad, we need a more refined shape scoring system that can better reflect patient-specific morphological features of the entire LA.