Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure
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Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure. / Kany, Shinwan; Skibowski, Johanna; Müller, Claus-Heinrich; Geist, Volker; Schmitt, Jörn; Niroomand, Feraydoon; Hailer, Birgit; Pleger, Sven; Akin, Ibrahim; Hochadel, Matthias; Senges, Jochen; Lubos, Edith.
in: CLIN RES CARDIOL, Jahrgang 112, Nr. 6, 06.2023, S. 824-833.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Association of atrial myopathy in mitral valve disease on safety outcomes in left atrial appendage closure
AU - Kany, Shinwan
AU - Skibowski, Johanna
AU - Müller, Claus-Heinrich
AU - Geist, Volker
AU - Schmitt, Jörn
AU - Niroomand, Feraydoon
AU - Hailer, Birgit
AU - Pleger, Sven
AU - Akin, Ibrahim
AU - Hochadel, Matthias
AU - Senges, Jochen
AU - Lubos, Edith
N1 - © 2023. The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - BACKGROUND: Patients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO.METHODS: Atrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO.RESULTS: A total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46-3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02-5.93, p < 0.001) but not MVD and atrial myopathy.CONCLUSION: Patients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.
AB - BACKGROUND: Patients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO.METHODS: Atrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO.RESULTS: A total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46-3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02-5.93, p < 0.001) but not MVD and atrial myopathy.CONCLUSION: Patients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.
KW - Humans
KW - Female
KW - Mitral Valve/diagnostic imaging
KW - Atrial Appendage/diagnostic imaging
KW - Atrial Fibrillation/complications
KW - Prospective Studies
KW - Heart Atria/diagnostic imaging
KW - Heart Valve Diseases/complications
KW - Stroke/etiology
KW - Muscular Diseases/complications
KW - Treatment Outcome
U2 - 10.1007/s00392-022-02151-7
DO - 10.1007/s00392-022-02151-7
M3 - SCORING: Journal article
C2 - 36739561
VL - 112
SP - 824
EP - 833
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 6
ER -
