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Impact of left atrial appendage closure on cardiac functional and structural remodeling: A Difference-in-Difference analysis of propensity score matched samples

Quang Tan Phan, Seung-Yong Shin, Ik-Sung Cho, Wang-Soo Lee, Hoyoun Won, Saima Sharmin, Dong-Young Lee, Tae-Ho Kim, Chee-Jeong Kim, Sang-Wook Kim
DOI: 10.5603/CJ.a2018.0047
·
Pubmed: 29718529

open access

Ahead of print
Original articles
Published online: 2018-04-25

Abstract

Background: Although the safety and efficacy of left atrial appendage (LAA) closure (LAAC) in nonvalvular atrial fibrillation (NVAF) patients have been well documented in randomized controlled trials and real-world experience, there are limited data in the literature about the impact of LAAC on cardiac remodeling. The aim of the study was to examine the impact of LAAC on cardiac functional and structural remodeling in NVAF patients. Methods: Between March 2014 and November 2016, 47 NVAF patients who underwent LAAC were included in this study (LAAC group). A control group (non-LAAC group) was formed from 141 NVAF patients without LAAC using propensity score matching. The Difference-in-Difference analysis was used to evaluate the difference in cardiac remodeling between the two groups at baseline and follow-up evaluations. Results: The LAAC group had a larger increase in left atrial dimension (LAD), volume (LAV) and volume index (LAVI) than the non-LAAC group (+3.9 mm, p = 0.001; +9.7 mL, p = 0.006 and +5.9 mL/m2, p = 0.011, respectively). Besides, a significant increase in E and E/e’ ratio was also observed in the LAAC group (+14.6 cm/s, p = 0.002 and +2.3, p = 0.028, respectively). Compared with the non-LAAC group, left ventricular ejection fraction and fractional shortening decreased in LAAC patients, but were statistically insignificant (–3.5%, p = 0.109 and –2.0%, p = 0.167, respectively). Conclusions: There were significant increases in LA size and LV filling pressure among NVAF patients after LAAC. These impacts of LAAC on cardiac functional and structural remodeling may have some clinical implications that need to be addressed in future studies.

Abstract

Background: Although the safety and efficacy of left atrial appendage (LAA) closure (LAAC) in nonvalvular atrial fibrillation (NVAF) patients have been well documented in randomized controlled trials and real-world experience, there are limited data in the literature about the impact of LAAC on cardiac remodeling. The aim of the study was to examine the impact of LAAC on cardiac functional and structural remodeling in NVAF patients. Methods: Between March 2014 and November 2016, 47 NVAF patients who underwent LAAC were included in this study (LAAC group). A control group (non-LAAC group) was formed from 141 NVAF patients without LAAC using propensity score matching. The Difference-in-Difference analysis was used to evaluate the difference in cardiac remodeling between the two groups at baseline and follow-up evaluations. Results: The LAAC group had a larger increase in left atrial dimension (LAD), volume (LAV) and volume index (LAVI) than the non-LAAC group (+3.9 mm, p = 0.001; +9.7 mL, p = 0.006 and +5.9 mL/m2, p = 0.011, respectively). Besides, a significant increase in E and E/e’ ratio was also observed in the LAAC group (+14.6 cm/s, p = 0.002 and +2.3, p = 0.028, respectively). Compared with the non-LAAC group, left ventricular ejection fraction and fractional shortening decreased in LAAC patients, but were statistically insignificant (–3.5%, p = 0.109 and –2.0%, p = 0.167, respectively). Conclusions: There were significant increases in LA size and LV filling pressure among NVAF patients after LAAC. These impacts of LAAC on cardiac functional and structural remodeling may have some clinical implications that need to be addressed in future studies.

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Keywords

left atrial appendage closure, atrial fibrillation, stroke prevention, diastolic function, systolic function, cardiac remodeling, Difference-in-Difference analysis

About this article
Title

Impact of left atrial appendage closure on cardiac functional and structural remodeling: A Difference-in-Difference analysis of propensity score matched samples

Journal

Cardiology Journal

Issue

Ahead of print

Published online

2018-04-25

DOI

10.5603/CJ.a2018.0047

Pubmed

29718529

Keywords

left atrial appendage closure
atrial fibrillation
stroke prevention
diastolic function
systolic function
cardiac remodeling
Difference-in-Difference analysis

Authors

Quang Tan Phan
Seung-Yong Shin
Ik-Sung Cho
Wang-Soo Lee
Hoyoun Won
Saima Sharmin
Dong-Young Lee
Tae-Ho Kim
Chee-Jeong Kim
Sang-Wook Kim

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