Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis
2
조회
0
다운로드
1
인용
0
참고문헌
초록
Background: After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incompleteocclusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAAorifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiaccomputerized tomography (CT) using a novel 3D analysis system. Methods: We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakageas the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients withoutperi-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined betweenthe IAS plane and the line, linking the LAA orifice center and foramen ovale. Results: Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was alsolarger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall,the patients’ LA reserve significantly decreased after the procedure (21.7 mm3 vs. 17.8 mm3, p = 0.035). However, we observed nosignificant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Conclusion: Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakageafter LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidatesfor LAA device closure.
Abstract
Background: After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incompleteocclusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAAorifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiaccomputerized tomography (CT) using a novel 3D analysis system. Methods: We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakageas the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients withoutperi-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined betweenthe IAS plane and the line, linking the LAA orifice center and foramen ovale. Results: Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was alsolarger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall,the patients’ LA reserve significantly decreased after the procedure (21.7 mm3 vs. 17.8 mm3, p = 0.035). However, we observed nosignificant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Conclusion: Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakageafter LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidatesfor LAA device closure.
참고문헌 (25)
- Kernan WN, "American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 2160~2236
- Reddy VY, "PROTECT AF Investigators. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation)trial", Circulation, 127, pp.720~729 (2013)
- Urena M, "Percutaneous left atrial appendage closure with the AMPLATZER cardiac plug device in patients with nonvalvular atrial fibrillation and contraindications to anticoagulation therapy", J Am Coll Cardiol, 62, pp.96~102 (2013)
- Viles-Gonzalez JF, "The clinical impact of incomplete left atrial appendage closure with the Watchman device in patients with atrial fibrillation : a PROTECT AF(percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation)substudy", J Am Coll Cardiol, 59, pp.923~929 (2012)
- Fender EA, "Atrial septal angulation varies widely in patients undergoing pulmonary vein isolation", J Invasive Cardiol, 26, pp.128~131 (2014)
- Gage BF, "Selecting patients with atrial fibrillation for anticoagulation : stroke risk stratification in patients taking aspirin", Circulation, 110, pp.2287~2292 (2004)
- Lip GY, "Identifying patients at high risk for stroke despite anticoagulation : a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort", Stroke, 41, pp.2731~2738 (2010)
- Veinot JP, "Anatomy of the normal left atrial appendage : a quantitative study of age-related changes in 500 autopsy hearts : implications for echocardiographic examination", Circulation, 96, pp.3112~3115 (1997)
- Aryana A, "Left atrial appendage occlusion and ligation devices: what is available, how to implement them, and how to manage and avoid complications", Curr Treat Options Cardiovasc Med, 14, pp.503~519 (2012)
- De Backer O, "Percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation : an update", Open Heart, 1, pp.000020~ (2014)
- Wang Y, "Left atrial appendage studied by computed tomography to help planning for appendage closure device placement", J Cardiovasc Electrophysiol, 21, pp.973~982 (2010)
- Di Biase L, "Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study", J Am Coll Cardiol, 60, pp.531~538 (2012)
- Ho IC, "Use of intracardiac echocardiography to guide implantation of a left atrial appendage occlusion device(PLAATO)", Heart Rhythm, 4, pp.567~571 (2007)
- Mráz T, "Role of echocardiography in percutaneous occlusion of the left atrial appendage", Echocardiography, 24, pp.401~404 (2007)
- Blendea D, "Analysis of the left atrial appendage morphology by intracardiac echocardiography in patients with atrial fibrillation", J Interv Card Electrophysiol, 31, pp.191~196 (2011)
- Bai R, "Intraprocedural and long-term incomplete occlusion of the left atrial appendage following placement of the WATCHMAN device : a single center experience", J Cardiovasc Electrophysiol, 23, pp.455~461 (2012)
- Merchant FM, "Site-specific transseptal cardiac catheterization guided by intracardiac echocardiography for emerging electrophysiology applications", J Innov Cardiac Rhythm Manage, 4, pp.1415~1427 (2013)
- Bayard YL, "PLAATO(percutaneous left atrial appendage transcatheter occlusion)for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients : results from the European PLAATO study", EuroIntervention, 6, pp.220~226 (2010)
- Freixa X, "Left atrial appendage closure with the Amplatzer™ Cardiac Plug : impact of shape and device sizing on follow-up leaks", Int J Cardiol, 168, pp.1023~1027 (2013)
- Neuzner J, "Left atrial appendage closure with the Amplatzer™ Cardiac Plug : Rationale for a higher degree of device oversizing at implantation", Cardiol J, 22, pp.201~205 (2015)
- Otani K, "Impact of diastolic dysfunction grade on left atrial mechanics assessed by two-dimensional speckle tracking echocardiography", J Am Soc Echocardiogr, 23, pp.961~967 (2010)
- Wong RC, "Left atrial volume is an independent predictor of exercise capacity in patients with isolated left ventricular diastolic dysfunction", Int J Cardiol, 144, pp.425~427 (2010)
- Kizer JR, "Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults : the Strong Heart Study(SHS)", Am Heart J, 151, pp.412~418 (2006)
- Tsang TS, "Prediction of risk for first age-related cardiovascular events in an elderly population : the incremental value of echocardiography", J Am Coll Cardiol, 42, pp.1199~1205 (2003)
- Chinali M, "Left atrial systolic force and cardiovascular outcome. The Strong Heart Study", Am J Hypertens, 18(12), pp.1570~1576 (2005)