Does Percutaneous Left Atrial Appendage Closure Affect Left Atrial Performance?

Abstract Background: Percutaneous left atrial appendage (LAA) occlusion may be an alternative therapy for atrial fibrillation (AF) patients with contraindication for anti-coagulation therapy. However, the influence of LAA occlusion on left atrial (LA) performance has not been studied. Objective: Our aim was to evaluate the influence of percutaneous LAA occlusion device on LA function by transthoracic echocardiography plus speckle-tracking echocardiography (STE). Methods: We included 16 patients undergoing percutaneous LAA closure with adequate echocardiographic window for the study of LA mechanics. Transthoracic echocardiography was performed before and after the procedure. LA volumes were calculated using the biplane method, and LA mechanics were assessed using STE. The analysis focused on the LA reservoir phase strain and strain rate. Results: Seventy-five percent of patients had permanent atrial fibrillation. Embolic and bleeding risk scores used were CHA2DS2-VASc [median of 4-5] and HAS-BLED [median of 2-3]. Major bleeding (62%) was the most common indication for the procedure. Percutaneous LAA closure was performed successfully in all patients, without major complications. No differences were found in maximum LA volume (44 ± 11 vs. 46 ± 13 mL/m2; p = 0.54), minimum LA volume (32 ± 8 vs. 37 ± 14 mL/m2; p = 0.09) or LA emptying fraction (26 ± 17 vs. 21 ± 14%; p = 0.33) before and after the procedure. Similarly, no differences were noted in left atrial strain (13.7 ± 11.1 vs. 13.0 ± 8.8%; p = 0.63) or strain rate (1.06 ± 0.26 vs. 1.13 ± 0.34 s-1; p = 0.38) in the reservoir phase. Conclusions: Our data suggest that percutaneous LAA closure does not affect LA reservoir function.

摘要 背景：经皮左心耳（left atrial appendage, LAA）封堵术可作为抗凝治疗禁忌的心房颤动（atrial fibrillation, AF）患者的替代治疗方案。然而，左心耳封堵术对左心房（left atrial, LA）功能的影响尚未得到研究。
目的：本研究旨在通过经胸超声心动图联合斑点追踪成像（speckle-tracking echocardiography, STE）评估经皮左心耳封堵器械对左心房功能的影响。
方法：本研究纳入16例接受经皮左心耳封堵术且满足左心房力学研究超声成像条件的患者，分别于术前及术后行经胸超声心动图检查。采用双平面法计算左心房容积，通过斑点追踪成像评估左心房力学性能，分析重点聚焦于左心房储器相应变及应变率。
结果：75%的患者为永久性心房颤动。所用的栓塞及出血风险评分分别为CHA₂DS₂-VASc评分（中位数4~5）与HAS-BLED评分（中位数2~3）。大出血（占比62%）为最常见的手术指征。所有患者均成功完成经皮左心耳封堵术，未发生重大并发症。术前与术后的左心房最大容积[(44±11) vs. (46±13) mL/m²; p=0.54]、左心房最小容积[(32±8) vs. (37±14) mL/m²; p=0.09]及左心房射血分数[(26±17)% vs. (21±14)%; p=0.33]均无显著差异。同样，储器相左心房应变[(13.7±11.1)% vs. (13.0±8.8)%; p=0.63]及应变率[(1.06±0.26) vs. (1.13±0.34) s⁻¹; p=0.38]亦无明显变化。
结论：本研究数据表明，经皮左心耳封堵术不会对左心房储器功能造成影响。