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Clinical relevance of incomplete device endothelialization after left atrial appendage closure

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Abstract

Purpose

This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization(IDE) after left atrial appendage closure (LAAC).

Methods

A total of 101 consecutive patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded.

Results

IDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not significantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32).

Conclusion

IDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.

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Acknowledgements

Not applicable.

Funding

This study was supported by Top-level Clinical Discipline Project of Shanghai Pudong District Grant(PWYgf2021-01), Training plan for discipline leaders of Shanghai Pudong New Area Health Commission Grant(PWRd2020-09), Programs of National Natural Science Foundation of China (82000378 and 82170477).

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Authors and Affiliations

  1. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Ji Mo Rd, 200120, Shanghai, China

    Jing Xu, Liang Wang, Bing Yang, Qi Zhang, Yun Li Shen & Jian Qiang Hu

  2. Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    Chuan Zhi Chen & Jun Xing

  3. Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China

    Yi Rao Tao

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  1. Jing Xu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JX, CZC, JX, LW and YRT. The first draft of the manuscript was written by JX and CZC. BY and QZ conducted a critical revision of manuscript. YLS and JQH was responsible for the revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yun Li Shen or Jian Qiang Hu.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the principles of the declaration of Helsinki and was approved by the hospital ethics committee.

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All patients provided their written informed consents.

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Consent for publication was obtained for every individual person’s data included in the study.

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Jing Xu and Chuan Zhi Chen contributed equally to this study.

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Xu, J., Chen, C.Z., Xing, J. et al. Clinical relevance of incomplete device endothelialization after left atrial appendage closure. Int J Cardiovasc Imaging 39, 451–459 (2023). https://doi.org/10.1007/s10554-022-02721-w

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