Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 23;10(5):e26792.
doi: 10.1016/j.heliyon.2024.e26792. eCollection 2024 Mar 15.

The impact of contrast retention on thrombus formation risks in patients with atrial fibrillation: A numerical study

Lan Ge  1   2 , Yawei Xu  3 , Jun Li  1   2 , Yuan Li  3 , Yifeng Xi  3 , Xinyan Wang  1   2 , Jing Wang  2 , Yang Mu  2 , Hongsen Wang  1   2 , Xu Lu  2 , Jun Guo  1   2 , Zengsheng Chen  3 , Tao Chen  1   2 , Yundai Chen  1   2
Affiliations

The impact of contrast retention on thrombus formation risks in patients with atrial fibrillation: A numerical study

Lan Ge et al. Heliyon. .

Abstract

Background: Contrast retention (CR) is an important predictor of left atrial appendage thrombus (LAAT) and stroke in patients with non-valvular atrial fibrillation (AF). We sought to explore the underlying mechanisms of CR using computational fluid dynamic (CFD) simulations.

Methods: A total of 12 patients with AF who underwent both cardiac computed tomography angiography (CTA) and transesophageal echocardiography (TEE) before left atrial appendage occlusion (LAAO) were included in the study. The patients were allocated into the CR group or non-CR group based on left atrial appendage (LAA) angiography. Patient-specific models were reconstructed to evaluate time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP). Additionally, the incidence of thrombosis was predicted using residence time (RT) at different time-points.

Results: TAWSS was lower [median (Interquartile Range) 0.27 (0.19-0.47) vs 1.35 (0.92-1.79), p < 0.001] in LAA compared to left atrium. In contrast, RRT [1438 (409.70-13869) vs 2.23 (1.81-3.14), p < 0.001] and ECAP [122.70 (30.01-625.70) vs 0.19 (0.16-0.27), p < 0.001)] was higher in the LAA. The patients in the CR group had significantly higher RRT [(mean ± SD) 16274 ± 11797 vs 639.70 ± 595.20, p = 0.009] and ECAP [610.80 ± 365.30 vs 54.26 ± 54.38, p = 0.004] in the LAA compared to the non-CR group. Additionally, patients with CR had a wider range of thrombus-prone regions [0.44(0.27-0.66)% vs 0.05(0.03-0.27)%, p = 0.009] at the end of the 15th cardiac cycle.

Conclusions: These findings suggest that CR might be an indicator of high-risk thrombus formation in the LAA. And CT-based CFD simulation may be a feasible substitute for the evaluation of LAA thrombotic risk in patients with AF, especially in patients with CR.

Keywords: Computational fluid dynamics (CFD); Contrast retention (CR); Left atrial appendage (LAA); Mechanism.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
A schematic depiction of the workflow designed and developed in this study. Firstly: patient-specific data processed to derive individualized LA/LAA anatomical CFD models. Secondly: personalized boundary conditions are applied for CFD simulation, and the simulation results were post-processed to derive hemodynamics indices. Thirdly: comparison of hemodynamic indices between the CR and non-CR groups based on the LAA angiography results. Abbreviations: CFD, computational fluid dynamics; CR, contrast retention.
Fig. 2
Fig. 2
Hemodynamic parameters comparison between LA and LAA (a, b); Hemodynamic parameters comparison between CR group and non-CR group in LA/LAA (c, d). Abbreviations: LA, left atrial; LAA, left atrial appendage; CR, contrast retention; TAWSS, time averaged wall shear stress; OSI, oscillatory shear index, RRT, the relative residence time; ECAP, the endothelial cell activation potential.
Fig. 3
Fig. 3
Patients' distribution of RRT and ECAP contours of the LA/LAA. Abbreviations: LA, left atrial; LAA, left atrial appendage; CR, contrast retention; RRT, the relative residence time; ECAP, the endothelial cell activation potential.
Fig. 4
Fig. 4
The distributions and thrombus volume proportions predicted by RT between CR group and non-CR group at the 15th cardiac cycle. Red indicates the thrombus-prone area. Abbreviations: CR, contrast retention.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kornej J., Borschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of atrial fibrillation in the 21st Century: Novel methods and new Insights. Circ. Res. 2020;127(1):4–20. - PMC - PubMed
    1. Wang T.J., Massaro J.M., Levy D., Vasan R.S., Wolf P.A., D'Agostino R.B., et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. JAMA. 2003;290(8):1049–1056. - PubMed
    1. Al-Saady N.M., Obel O.A., Camm A.J. Left atrial appendage: structure, function, and role in thromboembolism. Heart. 1999;82(5):547–554. - PMC - PubMed
    1. Beigel R., Wunderlich N.C., Ho S.Y., Arsanjani R., Siegel R.J. The left atrial appendage: anatomy, function, and noninvasive evaluation. JACC Cardiovasc Imaging. 2014;7(12):1251–1265. - PubMed
    1. Jiang L., Hao Z., Xie X., Xu K., Shen L., Pan X., et al. Left atrial appendage angiography for stroke risk prediction in patients with atrial fibrillation. EuroIntervention. 2023 - PMC - PubMed

LinkOut - more resources