Predictors of Subsequent Heart Failure After Left Atrial Appendage Closure

Abstract

Background: Left atrial appendage occlusion (LAAO) plays an important role in preventing stroke in patients with atrial fibrillation. However, LAAO may interact unfavorably with left atrial (LA) compliance and reservoir function and thus increase the risk of heart failure (HF). The purpose of this study was to identify predictors of subsequent HF after successful LAAO. Methods and Results:A total of 98 patients (mean age 70±9 years, 68% male) who had undergone LAAO were included. The primary endpoint was unexpected HF admission after LAAO. During a mean period of 36±26 months, 16 of the 98 patients (16%) experienced hospital HF admission. In multivariate analysis, higher E/e' (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.20, P=0.014), higher left ventricular mass index (HR 1.02, 95% CI 1.00-1.03, P=0.023), history of HF (HR 4.78, 95% CI 1.55-14.7, P=0.006), and lower LA strain (HR 0.80, 95% CI 0.70-0.93, P=0.003) were independently associated with hospital HF admission. Patients with LAAO had a significantly higher incidence of subsequent HF than the control group after propensity score matching (P=0.046).Conclusions: LAAO increases the occurrence of HF, and it is not uncommon after successful LAAO. A previous history of HF, left ventricular mass index, E/e', and abnormal LA strain are independently associated with the development of HF. These parameters should be considered before attempting LAAO.

Activities of Daily Living Predict Contrast-Associated Acute Kidney Injury among Population Undergoing Coronary Angiography

“…As predicted, the incidence of CA-AKI is increasing with the decline in BI scores. The decline in ADL is often accompanied by old age, organ dysfunction and increased comorbidities, such as diabetes and hypertension [23][24][25] . Advanced age is well recognized as a negative prognostic marker for CA-AKI [26,27] .…”

Stroke prevention in an octogenarian with atrial fibrillation, cerebral amyloid angiopathy and intracerebral hemorrhage

“…After LAAC a decrease of natriuretic peptide levels has been observed 9 . Consequently, LAAC may promote the development of heart failure (HF) 10 . HF, however, increases the risk for stroke in AF and has, therefore, been included in the CHADS 2 ‐ and CHA 2 DS 2 VASc‐score (C for congestive HF).…”

“…9 Consequently, LAAC may promote the development of heart failure (HF). 10 HF, however, increases the risk for stroke in AF and has, therefore, been included in the CHADS 2 ‐ and CHA 2 DS 2 VASc‐score (C for congestive HF). Overall, in our patient with an already elevated NT‐proBNP level, LAAC may be harmful since the procedure can result in congestive HF, thereby increasing his CHA 2 DS 2 ‐VASc‐score and his embolic risk.…”

Surgical and transcatheter left atrial appendage closure in patients with atrial fibrillation and hypertrophic cardiomyopathy

“…Interestingly, we observed a lower rate of heart failure admissions in the LAAC group, which is counter to previously reported data that LAAC may increase the rate of heart failure admissions. 19 Those who underwent LAAC were likely to be younger and as young patients are more likely to undergo myectomy, this cohort includes a large proportion of surgical LAAC. In contrast, percutaneous LAAC is often more commonly performed in the elderly.…”