Percutaneous Closure of Left Atrial Appendage significantly affects Lipidome Metabolism

Abstract

Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography–mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.

Targeted metabolomic analysis of serum phospholipid and acylcarnitine in the adult Fontan patient with a dominant left ventricle

“…raised end-diastolic pressures, hinting at altered diastolic and sustained systolic ventricular function. 40 In these atrial-fibrillation patients and in our patients, values for PL with fatty acids of higher carbon numbers were altered. However, whilst in the atrial-fibrillation patients analyte concentrations were higher than in controls, we found lower analyte concentrations in patients than in controls.…”

“…39 Findings in atrial-fibrillation patients with a biventricular system, in whom blood PL levels rose between closure of left atrial appendage (LAA) and 6 months thereafter, support the assumption that decreased PL levels in our patients indicate subtle stages of HF with slightly raised end-diastolic pressures, hinting at altered diastolic and sustained systolic ventricular function. 40 In these atrial-fibrillation patients and in our patients, values for PL with fatty acids of higher carbon numbers were altered. However, whilst in the atrial-fibrillation patients analyte concentrations were higher than in controls, we found lower analyte concentrations in patients than in controls.…”

A 79‐year‐old woman with atrial fibrillation and new onset of heart failure

“…16 In a recent publication, rehospitalizations for heart failure were reported in 17% of the patients after interventional LAA closure; however, the development of heart failure was attributed to pre-existing cardiac disease in this study. 22,23 At present, the clinical relevance of this phenomenon during long-term follow-up is unknown. 18,19 Progressive left atrial enlargement is a well-known phenomenon in permanent nAF and has also been documented after interventional LAA closure.…”

“…Further potentially disastrous consequences in our patient were a right atrial appendage thrombus and bidirectional interatrial shunting through a Apart from haemodynamic and endocrine consequences, LAA closure has been shown to affect glycolysis, tricarboxylic acid, urea, and lipidome metabolism. 22,23 At present, the clinical relevance of this phenomenon during long-term follow-up is unknown.…”

The Left Atrial Appendage, Including LAA Occlusion Devices Line Watchman, Amulet, and Lariat

“…Ultimately, the future of percutaneous LAA occlusion will depend on complications and on the long-term efficacy in stroke prevention. It will likely take decades to see if suggestions of altered lipidomes 47 have any significant clinical impact. On the other hand, persistent peridevice leak and device thrombosis do occur, 48 and there is likely room for improvement in post–LAA occlusion regimens for anticoagulation/antiplatelet therapy.…”