Department of Internal Medicine, Rochester Regional Health, Unity Hospital, Greece, New York, USA.
Department of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Clin Cardiol. 2022 Jun;45(6):614-621. doi: 10.1002/clc.23824. Epub 2022 Apr 2.
Left atrial (LA) appendage closure (LAAC) is effective in patients with atrial fibrillation who are not candidates for long-term anticoagulation. However, the impact of LAAC on LA function is unknown. The aim of this study is to evaluate the impact of LAAC on atrial function.
This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effect of LAAC on the LA function from inception to November 20, 2021. The standardized mean difference (SMD) was calculated from the means and standard deviations.
Of 247 studies initially identified, 8 studies comprising 260 patients were included in the final analysis. There was a significant increase in LA emptying fraction following LAAC compared with preoperative function (SMD: 0.53; 95% confidence interval [CI]: 0.04-1.01; p = .03; I = 75%). In contrast, there were no significant differences in LA volume (SMD: -0.07; 95% CI: -0.82-0.69; p = .86; I = 92%) peak atrial longitudinal strain (SMD: 0.50; 95% CI: -0.08-1.08; p = .09; I = 89%), peak atrial contraction strain (SMD: 0.38; 95% CI: -0.22-0.99; p = .21; I = 81%), strain during atrial contraction (SMD: -0.24; 95% CI: -0.61-0.13; p = .20; I = 0%), strain during ventricular systole (SMD: 0.47; 95% CI: -0.32-1.27; p = .24; I = 89%), strain during ventricular diastole (SMD: 0.09; 95% CI: -0.32-0.51; p = .66; I = 65%).
LAAC is associated with improvement in the left atrial emptying fraction, but did not significantly influence other parameters.
左心房（LA）附件闭合（LAAC）对不适合长期抗凝治疗的房颤患者有效。然而，LAAC 对 LA 功能的影响尚不清楚。本研究旨在评估 LAAC 对心房功能的影响。
本 meta 分析按照系统评价和荟萃分析的首选报告项目进行。设计了一种搜索策略，以利用 PubMed/Medline、EMBASE 和 Google scholar 从成立到 2021 年 11 月 20 日搜索显示 LAAC 对 LA 功能影响的研究。从平均值和标准差计算标准化均数差（SMD）。
最初确定的 247 项研究中有 8 项研究，共纳入 260 例患者，最终纳入分析。与术前功能相比，LAAC 后 LA 排空分数显著增加（SMD：0.53；95%置信区间[CI]：0.04-1.01；p=0.03；I 2 =75%）。相反，LA 容积（SMD：-0.07；95%CI：-0.82-0.69；p=0.86；I 2 =92%）、峰值心房纵向应变（SMD：0.50；95%CI：-0.08-1.08；p=0.09；I 2 =89%）、峰值心房收缩应变（SMD：0.38；95%CI：-0.22-0.99；p=0.21；I 2 =81%）、心房收缩时应变（SMD：-0.24；95%CI：-0.61-0.13；p=0.20；I 2 =0%）、心室收缩时应变（SMD：0.47；95%CI：-0.32-1.27；p=0.24；I 2 =89%）和心室舒张时应变（SMD：0.09；95%CI：-0.32-0.51；p=0.66；I 2 =65%）差异无统计学意义。
LAAC 与左心房排空分数的改善相关，但对其他参数无显著影响。
