First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Int J Cardiovasc Imaging. 2021 Jul;37(7):2291-2298. doi: 10.1007/s10554-021-02192-5. Epub 2021 Mar 5.
To bridge neo-endothelialization (NE) of implanted left atrial appendage closure (LAA/LAAC) devices, dual antiplatelet therapy is prescribed. Cardiac computed tomography angiography (cCTA) has been proposed for the evaluation of interventional LAAC. This prospective longitudinal observational study applied a standardized imaging protocol to detect progression of NE of LAAC devices 6 months after implantation.
Consecutive cCTA datasets of patients six months after LAAC were acquired and the standardized multi-planar reconstruction LAA occluder view for post-implantation evaluation (LOVE) algorithm was used. Residual flow of contrast agent inside the LAA without a peri-device leak (PDL) was defined as incomplete neo-endothelialization. Absence of residual flow was defined as complete neo-endothelialization. Since PDL allows residual flow in the LAA, irrespective of neoendothelialization, PDL were excluded from this study. Diabetes mellitus, liver disease, body-mass-index, age, device sizes and type will be assessed as predictors for incomplete NE.
53 consecutive patients were recruited for cCTA imaging. 36 (68%) showed no PDL and were included in the study (median age 77 years, 19% female). At median follow-up of 6 months (median 180 days, IQR 178-180), 44% of patients showed complete NE compared to 56% with NE still incomplete. Age, BMI, device type and size as well as prevalence of diabetes mellitus and liver disease did not show significant correlation with the completeness of NE.
This pilot study showed that neo-endothelialization is still incomplete in a majority of patients at mid-term follow-up of 6 months after successful LAAC therapy. Further investigation on the consequences of incomplete endothelialization is needed to guide antiplatelet therapy schedules.
为了桥接植入式左心耳封堵（LAA/LAAC）装置的新内皮化（NE），规定了双联抗血小板治疗。心脏计算机断层血管造影（cCTA）已被提议用于评估介入性 LAAC。这项前瞻性纵向观察研究应用标准化成像方案，在植入后 6 个月检测 LAAAC 装置的 NE 进展。
连续采集 LAAC 后 6 个月的患者 cCTA 数据集，并使用标准化多平面重建 LAA 封堵器视图进行植入后评估（LOVE）算法。在没有设备周围漏（PDL）的情况下，LAA 内对比剂的残余流动被定义为不完全新内皮化。无残余流动定义为完全新内皮化。由于 PDL 允许 LAA 内的残余流动，无论新内皮化如何，因此本研究排除了 PDL。糖尿病、肝病、体重指数、年龄、器械大小和类型将被评估为不完全 NE 的预测因素。
53 例连续患者接受 cCTA 成像。36 例（68%）无 PDL 并被纳入研究（中位年龄 77 岁，19%为女性）。在中位随访 6 个月（中位数 180 天，IQR 178-180）时，与 56%的不完全新内皮化患者相比，44%的患者表现出完全新内皮化。年龄、BMI、器械类型和大小以及糖尿病和肝病的患病率与新内皮化的完整性没有显著相关性。
这项初步研究表明，在成功 LAAC 治疗后 6 个月的中期随访中，大多数患者的新内皮化仍然不完全。需要进一步研究不完全内皮化的后果，以指导抗血小板治疗方案。
