Prognostic impact of increase in left atrial volume following left atrial appendage closure: Insights from the OCEAN-LAAC registry
Year: 2024
Type: article
Study design: Observational Study
Abstract: Boxplot (A) shows the change of LAVI at baseline, 6-month follow-up and 1-year follow-up, whereas histogram (B) depicts the LAVI difference value from baseline to 6-month follow-up. No significant change was observed in the analysis of the whole population (A), and a histogram shows a parametric distribution with some suspected outliers (B). Alluvial plot (C) represents the shift of population of LAVI quartiles from baseline to 6-month follow-up. Particular patients underwent the change in LAVI in each group, but the overall proportion apparently did not significantly change. Kaplan-Meier Curve for HFH according to the two groups with or without a 5 ml/m 2 increase in LAVI at 6-month follow-up (D) revealed that the patients with a 5 ml/m 2 increase in LAVI experienced more HFH than those without the increase. LAVI, left atrial volume index; HFH, heart failure hospitalization. Percutaneous left atrial appendage closure (LAAC) is an effective therapy to prevent thromboembolic events among patients with atrial fibrillation (AF). However, since the left atrial appendage (LAA) contributes to left atrial volume and serves as a buffer for increasing left atrial pressure, this procedure may impair left atrium (LA) compliance, enlarge LA, and deteriorate diastolic function. In this study, we sought to investigate the change in left atrial volume index (LAVI) following LAAC and its effect on prognosis. We analyzed 225 patients from the OCEAN-LAAC registry, an ongoing, multicenter Japanese study. Comparing LAVI measurements at baseline and 6 months after LAAC, no significant increase was observed (55.0 [44.0, 70.0] ml/m 2 vs. 55.0 [42.0, 75.6] ml/m 2 ; P = 0.31). However, some patients underwent LAVI increase. Particularly, a smaller LAVI (odds ratio [OR]: 0.98 [95 % confidence interval (CI): 0.97–0.996]) and elevated tricuspid regurgitation pressure (TRPG) at baseline (OR: 1.04 [95 % CI: 1.00 – 1.08]) were significantly related to the increase in LAVI at 6-month follow-up. In addition, a 5 ml/m 2 increase in LAVI was significantly associated with subsequent heart failure hospitalization (HFH) (hazard ratio: 3.37 [95 % CI: 1.18–9.65]). This association, however, was not observed in patients with lower baseline LAVI (≤55 ml/m 2 ) but was only seen in those with a baseline LAVI over 55 ml/m 2 . Our study demonstrated an increase in LAVI after LAAC was related to smaller LAVI or elevated TRPG at baseline. The LAVI increase was significantly associated with subsequent HFH.
Source: IJC Heart & Vasculature
Authors: Hideaki Nonaka, Masahiko Asami, Yu Horiuchi, Jun Tanaka, Daiki Yoshiura, Kota Komiyama, Hitomi Yuzawa, Kengo Tanabe, Mitsuru Sago, Shuhei Tanaka, Ryuki Chatani, Daisuke Hachinohe, Toru Naganuma, Yohei Ohno, Tomoyuki Tani, Hideharu Okamatsu, Kazuki Mizutani, Yusuke Watanabe, Masaki Izumo, Mike Saji, Shingo Mizuno, Hiroshi Ueno, Shunsuke Kubo, Shinichi Shirai, Masaki Nakashima, Masanori Yamamoto, Kentaro Hayashida
Institutions: Mitsui Memorial Hospital, Toyohashi Heart Center, Toyama University Hospital, University of Toyama, Kurashiki Central Hospital, New Tokyo Hospital, Tokai University, Saiseikai Kumamoto Hospital, Kindai University, Teikyo University, St. Marianna University School of Medicine, Toho University, Shonan Kamakura General Hospital, Kokura Memorial Hospital, Sendai Kousei Hospital, Nagoya Heart Center, Gifu Heart Center, Keio University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,930
OpenAlex ID: W4399880504