دورية أكاديمية
أعرض في EDS

Prognostic Impact of Left Atrial Appendage Patency After Device Closure.

التفاصيل البيبلوغرافية
العنوان: Prognostic Impact of Left Atrial Appendage Patency After Device Closure.
المؤلفون: Chen M; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Yao PC; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Fei ZT; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Wang QS; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Yu YC; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Zhang PP; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Li W; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Zhang R; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Mo BF; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Zhao MZ; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Yu Y; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Yang M; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Zhao Y; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Gong CQ; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Sun J; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China., Li YG; Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China.
المصدر: Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 May; Vol. 17 (5), pp. e013579. Date of Electronic Publication: 2024 Apr 17.
نوع المنشور: Journal Article; Observational Study
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101499602 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7632 (Electronic) Linking ISSN: 19417640 NLM ISO Abbreviation: Circ Cardiovasc Interv Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins
مواضيع طبية MeSH: Atrial Appendage*/physiopathology , Atrial Appendage*/diagnostic imaging , Atrial Fibrillation*/physiopathology , Atrial Fibrillation*/mortality , Atrial Fibrillation*/diagnosis , Atrial Fibrillation*/therapy , Atrial Fibrillation*/diagnostic imaging , Ischemic Attack, Transient*/etiology , Stroke*/etiology , Stroke*/mortality , Computed Tomography Angiography* , Cardiac Catheterization*/adverse effects , Cardiac Catheterization*/instrumentation, Humans ; Male ; Female ; Aged ; Prospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Aged, 80 and over ; Middle Aged ; Risk Assessment ; Hemorrhage ; Prosthesis Design
مستخلص: Background: The prognostic impact of left atrial appendage (LAA) patency, including those with and without visible peri-device leak (PDL), post-LAA closure in patients with atrial fibrillation, remains elusive.
Methods: Patients with atrial fibrillation implanted with the WATCHMAN 2.5 device were prospectively enrolled. The device surveillance by cardiac computed tomography angiography was performed at 3 months post-procedure. Adverse events, including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular death, all-cause death, and the combined major adverse events (MAEs), were compared between patients with complete closure and LAA patency.
Results: Among 519 patients with cardiac computed tomography angiography surveillance at 3 months post-LAA closure, 271 (52.2%) showed complete closure, and LAA patency was detected in 248 (47.8%) patients, including 196 (37.8%) with visible PDL and 52 (10.0%) without visible PDL. During a median of 1193 (787-1543) days follow-up, the presence of LAA patency was associated with increased risks of stroke/TIA (adjusted hazard ratio for baseline differences, 3.22 [95% CI, 1.17-8.83]; P =0.023) and MAEs (adjusted hazard ratio, 1.12 [95% CI, 1.06-1.17]; P =0.003). Specifically, LAA patency with visible PDL was associated with increased risks of stroke/TIA (hazard ratio, 3.66 [95% CI, 1.29-10.42]; P =0.015) and MAEs (hazard ratio, 3.71 [95% CI, 1.71-8.07]; P =0.001), although LAA patency without visible PDL showed higher risks of MAEs (hazard ratio, 3.59 [95% CI, 1.28-10.09]; P =0.015). Incidences of stroke/TIA (2.8% versus 3.0% versus 6.7% versus 22.2%; P =0.010), cardiovascular death (0.9% versus 0% versus 1.7% versus 11.1%; P =0.005), and MAEs (4.6% versus 9.0% versus 11.7% versus 22.2%; P =0.017) increased with larger PDL (0, >0 to ≤3, >3 to ≤5, or >5 mm). Older age and discontinuing antiplatelet therapy at 6 months were independent predictors of stroke/TIA and MAEs in patients with LAA patency.
Conclusions: LAA patency detected by cardiac computed tomography angiography at 3 months post-LAA closure is associated with unfavorable prognosis in patients with atrial fibrillation implanted with WATCHMAN 2.5 device.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03788941.
Competing Interests: Disclosures None.
فهرسة مساهمة: Keywords: atrial fibrillation; cardiac computed tomography angiography; incomplete device endothelialization; left atrial appendage closure; peri-device leak
سلسلة جزيئية: ClinicalTrials.gov NCT03788941
تواريخ الأحداث: Date Created: 20240417 Date Completed: 20240521 Latest Revision: 20240710
رمز التحديث: 20240710
مُعرف محوري في PubMed: PMC11097947
DOI: 10.1161/CIRCINTERVENTIONS.123.013579
PMID: 38629273
قاعدة البيانات: MEDLINE
الوصف
تدمد:1941-7632
DOI:10.1161/CIRCINTERVENTIONS.123.013579