Abstract Body: Background:
Exclusion of left atrial appendage (LAA) in animals reduces compliance and increases left atrial pressure. We hypothesize that percutaneous left atrial appendage occlusion (LAAO) would lead to structural and hemodynamic changes in left atrium and assess the risk using echocardiographic cut-offs used for evaluating left atrial pressure in heart failure patients.
Methods:
We queried TriNetx database for adult patients with heart failure undergoing percutaneous LAAO. We excluded those who underwent surgical or alternative percutaneous procedures pertaining to LAA, procedures pertaining to mitral valve (MV), mitral valvular pathologies, mechanical circulatory support placement, pacemaker placement, and those with left bundle branch block. We calculated risk of meeting echocardiographic cut-offs used in evaluation of left atrial pressure; MV maximum E-wave velocity ≥50cm/s, left atrial end systolic volume index (LAESVI) indexed to body surface area ≥34 ml/m2, Tricuspid Regurgitation systolic jet velocity ≥ 2.8 m/s, Pulmonary vein Systole/Diastole ratio ≤ 1, mitral valve lateral annulus E/e' ≥ 13 and Mitral valve E/A ratio ≥2. Those meeting the respective cut-off before LAAO were excluded. All diagnoses, procedures, and echocardiographic parameters were identified using International Classification of Diseases, Current Procedural Terminology, and Logical Observation Identifiers Names and Codes.
Results:
We identified 4,046 patients with heart failure undergoing percutaneous LAAO. Baseline demographics and diagnosis were; mean (SD) age 75.4 (8.1) years, 37% females, 92% hypertension, 67% ischemic heart disease, 42% diabetes mellitus, 41% chronic kidney disease, and 42% were overweight or obese. Risk of meeting echocardiographic cut-offs used in evaluating left atrial pressure was low with 0.24% (10) patients having LAESVI indexed to body surface area ≥34 ml/m2, Tricuspid Regurgitation systolic jet velocity ≥ 2.8 m/s, Pulmonary vein Systole/Diastole ratio ≤ 1, and Mitral valve E/A ratio ≥ 2. Risk of having MV maximum E-wave velocity ≥50cm/s was 0.58% and no patients had mitral valve lateral annulus E/e' ≥ 13. (Figure 1)
Conclusion:
Risk of meeting echocardiographic cut-offs used in evaluation of left atrial pressure in patients with heart failure undergoing percutaneous LAAO is low.