Division of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
Division of Cardiology and Intensive Care, Klinikum Lüneburg, Lüneburg, Germany.
Clin Res Cardiol. 2023 Jun;112(6):824-833. doi: 10.1007/s00392-022-02151-7. Epub 2023 Feb 5.
Patients undergoing left atrial appendage (LAA) occlusion (LAAO) are multi-morbid, including mitral valve disease (MVD) which is associated with anatomic changes of the left atrium (LA). This study aims to identify how atrial myopathy in MVD influences outcomes in LAAO.
Atrial myopathy in MVD was defined as LA diameter > 45 mm (♀) and > 48 mm (♂) and existing MVD or history of surgical/interventional treatment. Patients were compared with controls from the prospective, multicentre LAArge registry of LAAO.
A total of 528 patients (52 MVD, 476 no-MVD) were included. The MVD group was significantly more likely to be older (78.2 years vs 75.9 years, p = 0.036) and female (59.6% vs 37.8%, p = 0.002). Altered LA anatomy was observed in MVD with significantly larger LA diameter (53 mm vs. 48 mm, p < 0.001) and LAA Ostia [at 135° 23.0 mm (20.5, 26.0) vs 20.0 mm (18.0, 23.0), p = 0.002]. Implant success was high with 96.2% and 97.9%, respectively, without differences in severe complications (7.7% vs 4.6%, p = 0.31). One-year mortality (17.8% vs 11.5%, p = 0.19) and a combined outcome of death, stroke, and systemic embolism (20.3% vs 12.4%, p = 0.13) were not different. Independent predictors of the combined outcome were peripheral artery disease (HR 2.41, 95% CI 1.46-3.98, p < 0.001) and chronic kidney disease (HR 3.46, 95% CI 2.02-5.93, p < 0.001) but not MVD and atrial myopathy.
Patients with MVD present with altered LA anatomy with increased LA and LAA diameter. However, procedural success and safety in LAAO are not compromised. One-year mortality is numerically higher in patients with MVD but driven by comorbidities.
接受左心耳（LAA）封堵（LAAO）的患者多病共存，包括与左心房（LA）解剖结构变化相关的二尖瓣疾病（MVD）。本研究旨在确定 MVD 中的心房肌病如何影响 LAAO 的结果。
MVD 中的心房肌病定义为 LA 直径>45mm（♀）和>48mm（♂）以及存在 MVD 或既往外科/介入治疗史。将这些患者与前瞻性、多中心 LAAO 的 LAArge 登记处的对照组进行比较。
共纳入 528 例患者（52 例 MVD，476 例非 MVD）。MVD 组的年龄明显更大（78.2 岁 vs 75.9 岁，p=0.036），女性比例更高（59.6% vs 37.8%，p=0.002）。MVD 中观察到 LA 解剖结构改变，LA 直径明显更大（53mm vs 48mm，p<0.001），LAA 开口[在 135°处为 23.0mm（20.5，26.0）vs 20.0mm（18.0，23.0），p=0.002]。植入成功率高，分别为 96.2%和 97.9%，严重并发症无差异（7.7% vs 4.6%，p=0.31）。1 年死亡率（17.8% vs 11.5%，p=0.19）和死亡、卒中和全身性栓塞的联合结局（20.3% vs 12.4%，p=0.13）无差异。联合结局的独立预测因素为外周动脉疾病（HR 2.41，95%CI 1.46-3.98，p<0.001）和慢性肾脏病（HR 3.46，95%CI 2.02-5.93，p<0.001），而不是 MVD 和心房肌病。
MVD 患者表现为 LA 解剖结构改变，LA 和 LAA 直径增大。然而，LAAO 的程序成功率和安全性未受影响。MVD 患者的 1 年死亡率在数值上更高，但由合并症驱动。
