This study investigates the relationship between left atrial function and the development of pulmonary vein stump thrombus (PVST) following left upper lobectomy (LUL), utilizing cine-magnetic resonance imaging (cine-MRI) to assess the left atrial functional parameters and their association with thrombus formation.
With the increased recognition of PVST as a complication after lung surgery, particularly LUL, researchers conducted this study involving 91 patients, of whom 30 developed PVST and 61 did not. The study found significant differences between these groups, underscoring the clinical importance of assessing left atrial function post-surgery.
PVST, which has been reported to occur between 13.5% and 34% of the time following LUL, can lead to serious complications, such as embolisms affecting the brain and other organs. The exact mechanisms contributing to PVST formation remain unclear, but factors such as blood stasis and turbulent blood flow at the pulmonary vein stump are believed to play significant roles.
Utilizing cine-MRI, the research assessed parameters including left atrial end-systolic volume (LAESV), left atrial end-diastolic volume (LAEDV), and left atrial ejection fraction (LAEF) among others. Findings indicated notable increases in LAESV and LAEDV for patients who developed PVST, paired with lower LAEF values. For example, those with PVST had LAEF scores of 35% on average compared to 45% for those without PVST, highlighting how left atrial dysfunction is associated with thrombus formation.
These differences were statistically significant, with p-values showing notable variances, such as p < 0.001 for LAEF, and multivariate analysis indicated LAEF was the sole independent predictor of PVST development, with odds ratio (OR) at 0.896. Such insights suggest enhancing the risk stratification for patients undergoing LUL could be feasible through left atrial assessments.
The study also looked at the anatomical aspect of the pulmonary vein stump, noting longer lengths correlated with PVST, which aligns with previous findings from other research groups. With LA dilation promoting blood stasis, the potential for thrombus incidents increases, reinforcing the importance of monitoring left atrial function closely.
Interestingly, the study concluded by proposing the integration of cine-MRI evaluations of the left atrium as part of routine care for patients post-LUL. This could allow for more timely and effective interventions aimed at preventing PVST, reducing the associated risks of embolism, and improving overall patient outcomes.