Left atrial appendage morphology and hemodynamics: potential new markers for individualized thromboembolic risk assessment in atrial fibrillation.
- 1Department of Joint and Sports Medicine, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
- 2Department of Cardiology, Xinhua Hospital Affiliated to Dalian University, Dalian, Liaoning, China.
- 3Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning, China.
Abstract
Background
Traditional CHA₂DS₂-VASc scoring has well-recognized limitations in thromboembolic risk assessment for atrial fibrillation (AF), particularly in low-score patients who nevertheless thrombose, high-score event-free individuals, cancer patients, and post-ablation cohorts. The left atrial appendage (LAA) is the source of 98% of thrombi in non-valvular AF and exhibits marked inter-individual morphological and hemodynamic variability that traditional scores completely ignore.Aims
This narrative review critically evaluates current evidence on LAA morphology, hemodynamics, computational fluid dynamics/fluid-structure interaction (CFD/FSI) studies, and digital twin technology, and proposes a mechanism-driven, individualized risk assessment framework for AF-related thromboembolism.Methods
A literature search was conducted in PubMed/MEDLINE and Web of Science (1990-May 2026) using combinations of keywords related to LAA morphology, hemodynamics, AF, and thromboembolism. Priority was given to landmark original studies, high-quality observational studies with multivariable adjustment, meta-analyses, and contemporary CFD/digital twin studies. A narrative synthesis was adopted owing to heterogeneity in study designs and outcomes.Results
LAA morphological subtypes are associated with long-term stroke risk, with chicken-wing being protective (OR 0.21, 95% CI 0.05-0.91) and cauliflower carrying the highest risk (OR 8.02, 95% CI 0.92-27.86). However, risk is highly context-dependent, with chicken-wing unexpectedly increasing peri-ablation thromboembolic risk (OR 7.2, 95% CI 1.35-38.33) and windsock morphology independently predicting post-ablation AF recurrence (OR 2.72, 95% CI 1.21-6.12). Importantly, traditional morphological classification does not correlate directly with blood stasis (p = 0.365), whereas quantitative geometric parameters such as trabecular number, normalized stroke volume, and ostial area are far more sensitive predictors (R² = 74%). Digital twins integrating multimodal clinical, morphological, and hemodynamic data identify a high-risk phenogroup with a 70% thrombus history rate.Conclusion
Based on these findings, we propose a practical two-tier assessment framework combining basic morphological classification with multimodal refined evaluation (digital twin) for intermediate-/high-risk or clinically challenging cases. This framework represents a paradigm shift from static clinical scores toward mechanism-driven, individualized risk management. Prospective validation of this approach is now warranted.
Related
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BibTeX
@article{liu2026left,
title = {{Left atrial appendage morphology and hemodynamics: potential new markers for individualized thromboembolic risk assessment in atrial fibrillation.}},
author = {Bingxin Liu and Xianyong Liu and Changlin Zhang and Henan Zhao},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1924120},
url = {https://europepmc.org/article/MED/42903262},
note = {CC BY},
}
RIS
TY - JOUR
TI - Left atrial appendage morphology and hemodynamics: potential new markers for individualized thromboembolic risk assessment in atrial fibrillation.
AU - Bingxin Liu
AU - Xianyong Liu
AU - Changlin Zhang
AU - Henan Zhao
PY - 2026
DA - 2026/10/06
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1924120
UR - https://europepmc.org/article/MED/42903262
AB - Background Traditional CHA₂DS₂-VASc scoring has well-recognized limitations in thromboembolic risk assessment for atrial fibrillation (AF), particularly in low-score patients who nevertheless thrombose, high-score event-free individuals, cancer patients, and post-ablation cohorts. The left atrial appendage (LAA) is the source of 98% of thrombi in non-valvular AF and exhibits marked inter-individual morphological and hemodynamic variability that traditional scores completely ignore.Aims This narrative review critically evaluates current evidence on LAA morphology, hemodynamics, computational fluid dynamics/fluid-structure interaction (CFD/FSI) studies, and digital twin technology, and proposes a mechanism-driven, individualized risk assessment framework for AF-related thromboembolism.Methods A literature search was conducted in PubMed/MEDLINE and Web of Science (1990-May 2026) using combinations of keywords related to LAA morphology, hemodynamics, AF, and thromboembolism. Priority was given to landmark original studies, high-quality observational studies with multivariable adjustment, meta-analyses, and contemporary CFD/digital twin studies. A narrative synthesis was adopted owing to heterogeneity in study designs and outcomes.Results LAA morphological subtypes are associated with long-term stroke risk, with chicken-wing being protective (OR 0.21, 95% CI 0.05-0.91) and cauliflower carrying the highest risk (OR 8.02, 95% CI 0.92-27.86). However, risk is highly context-dependent, with chicken-wing unexpectedly increasing peri-ablation thromboembolic risk (OR 7.2, 95% CI 1.35-38.33) and windsock morphology independently predicting post-ablation AF recurrence (OR 2.72, 95% CI 1.21-6.12). Importantly, traditional morphological classification does not correlate directly with blood stasis (p = 0.365), whereas quantitative geometric parameters such as trabecular number, normalized stroke volume, and ostial area are far more sensitive predictors (R² = 74%). Digital twins integrating multimodal clinical, morphological, and hemodynamic data identify a high-risk phenogroup with a 70% thrombus history rate.Conclusion Based on these findings, we propose a practical two-tier assessment framework combining basic morphological classification with multimodal refined evaluation (digital twin) for intermediate-/high-risk or clinically challenging cases. This framework represents a paradigm shift from static clinical scores toward mechanism-driven, individualized risk management. Prospective validation of this approach is now warranted.
SN - 2297-055X
ER -