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Abstract：
BACKGROUND: Both atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. If the two exist together, the risk of stroke, hospitalization for HF and all-cause death is increased. Currently, research on left atrial appendage closure (LAAC) in patients with AF and HF is limited and controversial. This study was designed to investigate the safety and effectiveness of LAAC in AF patients with different types of HF.
METHODS: Patients with non-valvular atrial fibrillation (NVAF) and HF who underwent LAAC in the First Affiliated Hospital of Army Medical University from August 2014 to July 2021 were enrolled. According to left ventricular ejection fraction (LVEF), the study divided into HF with reduced ejection fraction (LVEF < 50%, HFrEF) group and HF with preserved ejection fraction (LVEF ≥ 50%, HFpEF) group. The data we collected from patients included: gender, age, comorbid diseases, CHA2DS2-VASc score, HAS-BLED score, NT-proBNP level, residual shunt, cardiac catheterization results, occluder size, postoperative medication regimen, transthoracic echocardiography (TTE) results and transesophageal echocardiography (TEE) results, etc. Patients were followed up for stroke, bleeding, device related thrombus (DRT), pericardial tamponade, hospitalization for HF, and all-cause death within 2 years after surgery. Statistical methods were used to compare the differences in clinical outcome of LAAC in AF patients with different types of HF.
RESULTS: Overall, 288 NVAF patients with HF were enrolled in this study, including 142 males and 146 females. There were 74 patients in the HFrEF group and 214 patients in the HFpEF group. All patients successfully underwent LAAC. The CHA2DS2-VASc score and HAS-BLED score of HFrEF group were lower than those of HFpEF group. A total of 288 LAAC devices were implanted. The average diameter of the occluders was 27.2 ± 3.5 mm in the HFrEF group and 26.8 ± 3.3 mm in the HFpEF group, and there was no statistical difference between the two groups (P = 0.470). Also, there was no statistically significant difference in the occurrence of residual shunts between the two groups as detected by TEE after surgery (P = 0.341). LVEF was significantly higher in HFrEF group at 3 days, 3 months and 1 year after operation than before (P < 0.001). At 45-60 days after surgery, we found DRT in 9 patients and there were 4 patients (5.4%) in HFrEF group and 5 patients (2.3%) in HFpEF group, with no significant difference between the two groups (P = 0.357). One patient with DRT had stroke. The incidence of stroke was 11.1% in patients with DRT and 0.7% in patients without DRT (P = 0.670). There was one case of postoperative pericardial tamponade, which was improved by pericardiocentesis at 24 h after surgery in the HFpEF group, and there was no significant difference between the two groups (P = 1.000). During a mean follow-up period of 49.7 ± 22.4 months, there were no significant differences in the incidence of stroke, bleeding, DRT and HF exacerbation between the two groups. We found a statistical difference in the improvement of HF between HFrEF group and HFpEF group (P < 0.05).
CONCLUSIONS: LAAC is safe and effective in AF patients with different types of HF. The improvement of cardiac function after LAAC is more pronounced in HFrEF group than in HFpEF group.
METHODS: Patients with non-valvular atrial fibrillation (NVAF) and HF who underwent LAAC in the First Affiliated Hospital of Army Medical University from August 2014 to July 2021 were enrolled. According to left ventricular ejection fraction (LVEF), the study divided into HF with reduced ejection fraction (LVEF < 50%, HFrEF) group and HF with preserved ejection fraction (LVEF ≥ 50%, HFpEF) group. The data we collected from patients included: gender, age, comorbid diseases, CHA2DS2-VASc score, HAS-BLED score, NT-proBNP level, residual shunt, cardiac catheterization results, occluder size, postoperative medication regimen, transthoracic echocardiography (TTE) results and transesophageal echocardiography (TEE) results, etc. Patients were followed up for stroke, bleeding, device related thrombus (DRT), pericardial tamponade, hospitalization for HF, and all-cause death within 2 years after surgery. Statistical methods were used to compare the differences in clinical outcome of LAAC in AF patients with different types of HF.
RESULTS: Overall, 288 NVAF patients with HF were enrolled in this study, including 142 males and 146 females. There were 74 patients in the HFrEF group and 214 patients in the HFpEF group. All patients successfully underwent LAAC. The CHA2DS2-VASc score and HAS-BLED score of HFrEF group were lower than those of HFpEF group. A total of 288 LAAC devices were implanted. The average diameter of the occluders was 27.2 ± 3.5 mm in the HFrEF group and 26.8 ± 3.3 mm in the HFpEF group, and there was no statistical difference between the two groups (P = 0.470). Also, there was no statistically significant difference in the occurrence of residual shunts between the two groups as detected by TEE after surgery (P = 0.341). LVEF was significantly higher in HFrEF group at 3 days, 3 months and 1 year after operation than before (P < 0.001). At 45-60 days after surgery, we found DRT in 9 patients and there were 4 patients (5.4%) in HFrEF group and 5 patients (2.3%) in HFpEF group, with no significant difference between the two groups (P = 0.357). One patient with DRT had stroke. The incidence of stroke was 11.1% in patients with DRT and 0.7% in patients without DRT (P = 0.670). There was one case of postoperative pericardial tamponade, which was improved by pericardiocentesis at 24 h after surgery in the HFpEF group, and there was no significant difference between the two groups (P = 1.000). During a mean follow-up period of 49.7 ± 22.4 months, there were no significant differences in the incidence of stroke, bleeding, DRT and HF exacerbation between the two groups. We found a statistical difference in the improvement of HF between HFrEF group and HFpEF group (P < 0.05).
CONCLUSIONS: LAAC is safe and effective in AF patients with different types of HF. The improvement of cardiac function after LAAC is more pronounced in HFrEF group than in HFpEF group.
摘要：
背景：心房颤动（AF）和心力衰竭（HF）都是常见的心血管疾病。如果两者一起存在,中风的风险，HF住院和全因死亡增加.目前,房颤和HF患者左心耳封堵术(LAAC)的研究有限且存在争议.本研究旨在研究LAAC在不同类型HF的AF患者中的安全性和有效性。
方法：选择2014年8月至2021年7月在陆军医科大学第一附属医院接受LAAC治疗的非瓣膜性心房颤动(NVAF)合并HF患者。根据左心室射血分数（LVEF），该研究分为射血分数降低的HF（LVEF<50％，HFrEF组）和射血分数保留的HF（LVEF≥50％，HFpEF)组。我们从患者那里收集的数据包括：性别，年龄,共病，CHA2DS2-VASc评分,BLED得分,NT-proBNP水平,残余分流,心导管检查结果,封堵器大小,术后用药方案,经胸超声心动图（TTE）结果和经食管超声心动图（TEE）结果，等。对中风患者进行了随访，出血,装置相关血栓(DRT),心包填塞,HF住院治疗，手术后2年内全因死亡。采用统计学方法比较不同类型HF房颤患者LAAC临床转归的差异。
结果：总体而言，本研究纳入了288名患有HF的NVAF患者，其中男性142人，女性146人。HFrEF组74例，HFpEF组214例。所有患者均成功接受LAAC治疗。HFrEF组的CHA2DS2-VASc评分和HAS-BLED评分均低于HFpEF组。总共植入288个LAAC装置。封堵器平均直径HFrEF组为27.2±3.5mm,HFpEF组为26.8±3.3mm,两组间差异无统计学意义(P=0.470)。此外，术后经TEE检测,两组间残余分流的发生率差异无统计学意义(P=0.341).3天时HFrEF组LVEF显著增高，术后3个月和1年较术前(P<0.001)。手术后45-60天,我们发现9例患者有DRT，HFrEF组4例（5.4%），HFpEF组5例（2.3%），两组间无显著性差异(P=0.357)。一名DRT患者中风。DRT患者的卒中发生率为11.1%，无DRT患者的卒中发生率为0.7%(P=0.670)。术后有1例心包填塞,HFpEF组在手术后24小时通过心包穿刺术得到改善，两组间差异无统计学意义(P=1.000)。在平均49.7±22.4个月的随访期间，中风的发生率没有显着差异，出血,两组之间DRT和HF加重。我们发现HFrEF组与HFpEF组之间HF的改善具有统计学差异（P<0.05）。
结论：LAAC对不同类型HF的房颤患者安全有效。与HFpEF组相比，HFrEF组LAAC后心功能的改善更为明显。
方法：选择2014年8月至2021年7月在陆军医科大学第一附属医院接受LAAC治疗的非瓣膜性心房颤动(NVAF)合并HF患者。根据左心室射血分数（LVEF），该研究分为射血分数降低的HF（LVEF<50％，HFrEF组）和射血分数保留的HF（LVEF≥50％，HFpEF)组。我们从患者那里收集的数据包括：性别，年龄,共病，CHA2DS2-VASc评分,BLED得分,NT-proBNP水平,残余分流,心导管检查结果,封堵器大小,术后用药方案,经胸超声心动图（TTE）结果和经食管超声心动图（TEE）结果，等。对中风患者进行了随访，出血,装置相关血栓(DRT),心包填塞,HF住院治疗，手术后2年内全因死亡。采用统计学方法比较不同类型HF房颤患者LAAC临床转归的差异。
结果：总体而言，本研究纳入了288名患有HF的NVAF患者，其中男性142人，女性146人。HFrEF组74例，HFpEF组214例。所有患者均成功接受LAAC治疗。HFrEF组的CHA2DS2-VASc评分和HAS-BLED评分均低于HFpEF组。总共植入288个LAAC装置。封堵器平均直径HFrEF组为27.2±3.5mm,HFpEF组为26.8±3.3mm,两组间差异无统计学意义(P=0.470)。此外，术后经TEE检测,两组间残余分流的发生率差异无统计学意义(P=0.341).3天时HFrEF组LVEF显著增高，术后3个月和1年较术前(P<0.001)。手术后45-60天,我们发现9例患者有DRT，HFrEF组4例（5.4%），HFpEF组5例（2.3%），两组间无显著性差异(P=0.357)。一名DRT患者中风。DRT患者的卒中发生率为11.1%，无DRT患者的卒中发生率为0.7%(P=0.670)。术后有1例心包填塞,HFpEF组在手术后24小时通过心包穿刺术得到改善，两组间差异无统计学意义(P=1.000)。在平均49.7±22.4个月的随访期间，中风的发生率没有显着差异，出血,两组之间DRT和HF加重。我们发现HFrEF组与HFpEF组之间HF的改善具有统计学差异（P<0.05）。
结论：LAAC对不同类型HF的房颤患者安全有效。与HFpEF组相比，HFrEF组LAAC后心功能的改善更为明显。
