Abstract：
BACKGROUND: The hemodynamic effects of transcatheter left atrial appendage occlusion (LAAO) remain unclear.
OBJECTIVE: We sought to assess the effect of LAAO on invasive hemodynamics and their correlation with clinical outcomes.
METHODS: We recorded mean left atrial pressure (mLAP) before and after device deployment. We assessed the prevalence and predictors of mLAP increase after deployment, the association between significant mLAP increase after deployment and 45-day peridevice leak (PDL), and the association between mLAP increase and heart failure (HF) hospitalization. A significant mLAP increase was defined as one equal to or greater than the mean percentage increase in mLAP after deployment (≥28%).
RESULTS: We included 302 patients (36.4% female; mean age, 75.8 ± 9.5 years). After deployment, mLAP increased in 48% of patients, 38% of whom experienced significant mLAP increase. Independent predictors of mLAP increase were baseline mLAP ≤14 mm Hg, nonparoxysmal atrial fibrillation, and age per 5 years (odds ratios: 3.66 [95% CI, 2.21-6.05], 1.81 [95% CI, 1.08-3.02], and 0.85 [95% CI, 0.73-0.99], respectively). Significant mLAP increase was an independent predictor of 45-day PDL (odds ratio, 2.55; 95% CI, 1.04-6.26). There was no association between mLAP increase and HF hospitalization.
CONCLUSIONS: After deployment, mLAP acutely rises in 48% of patients, although this is not associated with increased HF hospitalizations. PDL is more likely to develop at 45 days in patients with significant increase in mLAP after deployment, although most leaks were small (<5 mm). These findings suggest that mLAP increase after deployment is not associated with major safety concerns. Additional studies are warranted to explore the long-term hemodynamic effects of LAAO.
OBJECTIVE: We sought to assess the effect of LAAO on invasive hemodynamics and their correlation with clinical outcomes.
METHODS: We recorded mean left atrial pressure (mLAP) before and after device deployment. We assessed the prevalence and predictors of mLAP increase after deployment, the association between significant mLAP increase after deployment and 45-day peridevice leak (PDL), and the association between mLAP increase and heart failure (HF) hospitalization. A significant mLAP increase was defined as one equal to or greater than the mean percentage increase in mLAP after deployment (≥28%).
RESULTS: We included 302 patients (36.4% female; mean age, 75.8 ± 9.5 years). After deployment, mLAP increased in 48% of patients, 38% of whom experienced significant mLAP increase. Independent predictors of mLAP increase were baseline mLAP ≤14 mm Hg, nonparoxysmal atrial fibrillation, and age per 5 years (odds ratios: 3.66 [95% CI, 2.21-6.05], 1.81 [95% CI, 1.08-3.02], and 0.85 [95% CI, 0.73-0.99], respectively). Significant mLAP increase was an independent predictor of 45-day PDL (odds ratio, 2.55; 95% CI, 1.04-6.26). There was no association between mLAP increase and HF hospitalization.
CONCLUSIONS: After deployment, mLAP acutely rises in 48% of patients, although this is not associated with increased HF hospitalizations. PDL is more likely to develop at 45 days in patients with significant increase in mLAP after deployment, although most leaks were small (<5 mm). These findings suggest that mLAP increase after deployment is not associated with major safety concerns. Additional studies are warranted to explore the long-term hemodynamic effects of LAAO.
摘要：
背景：经导管左心耳封堵术（LAAO）的血流动力学影响尚不清楚。
目的：我们试图评估LAAO对侵入性血流动力学的影响及其与临床结局的相关性。
方法：我们记录了设备部署前后的平均左心房压（mLAP）。我们评估了：（a）mLAP在部署后增加的患病率和预测因素；（b）mLAP在部署后显著增加与45天设备周围渗漏（PDL）之间的关联；（c）mLAP增加与心力衰竭（HF）住院之间的关联。mLAP显著增加定义为等于或大于部署后mLAP平均增加百分比(≥28%)。
结果：我们纳入了302例患者（女性占36.4％；平均年龄，75.8±9.5年）。部署后,在48.0％的患者中，mLAP增加，38.0%的人经历了显著的mLAP增加。mLAP升高的独立预测因子是基线mLAP≤14mmHg，非阵发性心房颤动,和年龄（比值比：3.66；95CI2.21-6.05，1.81；95CI1.08-3.02和0.85（每5年）；95CI分别为0.73-0.99）。显著的mLAP升高是45天PDL的独立预测因子(OR:2.55;95CI1.04-6.26)。mLAP增加与HF住院之间没有关联。
结论：48％的患者部署后MLAP急剧上升，尽管这与HF住院率增加无关。部署后mLAP显着增加的患者在45天更有可能发生PDL，尽管大多数泄漏很小（<5毫米）。这些发现表明，部署后mLAP的增加与重大安全问题无关。需要更多的研究来探索LAAO的长期血流动力学效应。
目的：我们试图评估LAAO对侵入性血流动力学的影响及其与临床结局的相关性。
方法：我们记录了设备部署前后的平均左心房压（mLAP）。我们评估了：（a）mLAP在部署后增加的患病率和预测因素；（b）mLAP在部署后显著增加与45天设备周围渗漏（PDL）之间的关联；（c）mLAP增加与心力衰竭（HF）住院之间的关联。mLAP显著增加定义为等于或大于部署后mLAP平均增加百分比(≥28%)。
结果：我们纳入了302例患者（女性占36.4％；平均年龄，75.8±9.5年）。部署后,在48.0％的患者中，mLAP增加，38.0%的人经历了显著的mLAP增加。mLAP升高的独立预测因子是基线mLAP≤14mmHg，非阵发性心房颤动,和年龄（比值比：3.66；95CI2.21-6.05，1.81；95CI1.08-3.02和0.85（每5年）；95CI分别为0.73-0.99）。显著的mLAP升高是45天PDL的独立预测因子(OR:2.55;95CI1.04-6.26)。mLAP增加与HF住院之间没有关联。
结论：48％的患者部署后MLAP急剧上升，尽管这与HF住院率增加无关。部署后mLAP显着增加的患者在45天更有可能发生PDL，尽管大多数泄漏很小（<5毫米）。这些发现表明，部署后mLAP的增加与重大安全问题无关。需要更多的研究来探索LAAO的长期血流动力学效应。
