The left atrial appendage morphology and gender differences by multi-detector computed tomography in an Egyptian population

BACKGROUND: The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation. Unique LAA morphologies have been associated with the risk of thromboembolism. This study investigates the LAA anatomy in the Egyptian population using cardiac multi-detector computed tomography (MDCT). RESULTS: We included 252 consecutive patients presenting for coronary computed tomography angiography in 2 tertiary centers in Egypt in the period from January to July 2017. Patients with atrial fibrillation, valvular affection, or left ventricular dysfunction were excluded. Two and three-dimensional cardiac MDCT images were assessed for LAA morphology, volume, length, and orifice position. The distribution of LAA morphologies was windsock (32.5%), chicken wing (25.4%), cauliflower (22.6%), and cactus (19.4%). Differences in the LAA dimensions in the 4 morphological variants were described. Females were less likely to have a chicken wing LAA morphology compared to males (7.9% vs 34.7%, p value < 0.01), and had a larger LAA volume, smaller LAA length, and a higher prevalence of high LAA orifice position. CONCLUSIONS: The most common LAA morphology in our study population is windsock, which may represent the Egyptian population or patients in sinus rhythm. Females were less likely to have a chicken wing LAA morphology, and had a larger LAA volume, smaller length, and higher incidence of high orifice position. Clinical correlation into the translation of these differences into thromboembolic risk is required.