Wang Kexin, Wang Zhe, Jin Caiyi, Xu Mingjia, Li Mingfang, Liu Hailei, Wang Zidun, Chen Hongwu, Ju Weizhu, Chen Minglong
Division of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China.
Department of Cardiology Affiliated Hospital 2 of Nantong University Nantong China.
J Am Heart Assoc. 2025 Feb 4;14(3):e037968. doi: 10.1161/JAHA.124.037968. Epub 2025 Feb 3.
Left atrial appendage occlusion (LAAO) was associated with a high incidence of procedure-related silent cerebral embolism (SCE). There are limited data regarding the long-term cognitive trajectory of patients undergoing LAAO. The aim of our study was to comprehensively assess the acute and long-term impact of SCE during and after LAAO.
Consecutive patients with atrial fibrillation referred for LAAO from the First Affiliated Hospital with Nanjing Medical University between February 2021 and February 2023 were included. All patients underwent magnetic resonance imaging and cognitive assessments before and within 48 hours after the procedure. These evaluations were also repeated at 45-day, 3-month, 6-month, and 1-year follow up.
Out of 75 patients included in the final analysis, 29 (38.7%) patients suffered from new SCE during LAAO. Patients with SCE exhibited a significant decline in cognitive function (Mini-Mental State Examination) immediately after the procedure (<0.001), which was not reversible during 1-year follow-up (<0.001). Additionally, with time going on, the gap in cognitive function between patients with and without SCE became wider (SCE × 1 year: B=-4.81 [95% CI, -5.58 to -4.05]; <0.001). New-onset SCE was detected in 11 (14.7%) patients during the follow-up magnetic resonance imaging, which also showed a decline in cognitive function (=0.004). The results in Montreal Cognitive Assessment scores were consistent with Mini-Mental State Examination.
LAAO-related SCE is associated with a marked impairment in cognitive function immediately after the procedure and is irreversible over a 1-year follow-up. New magnetic resonance-detected SCE during follow-up after LAAO would also be associated with a decline in cognitive function.
左心耳封堵术（LAAO）与手术相关的无症状性脑栓塞（SCE）高发生率相关。关于接受LAAO治疗患者的长期认知轨迹的数据有限。我们研究的目的是全面评估LAAO期间及之后SCE的急性和长期影响。
纳入2021年2月至2023年2月期间从南京医科大学第一附属医院转诊接受LAAO治疗的连续性房颤患者。所有患者在手术前及术后48小时内接受磁共振成像和认知评估。这些评估在45天、3个月、6个月和1年随访时也重复进行。
在最终分析纳入的75例患者中，29例（38.7%）患者在LAAO期间发生新的SCE。发生SCE的患者在术后立即出现认知功能（简易精神状态检查表）显著下降（<0.001），在1年随访期间不可逆转（<0.001）。此外，随着时间推移，有SCE和无SCE患者之间的认知功能差距变得更大（SCE×1年：B=-4.81[95%CI，-5.58至-4.05]；<0.001）。在随访磁共振成像期间，11例（14.7%）患者检测到新发SCE，其认知功能也有下降（=0.004）。蒙特利尔认知评估量表得分结果与简易精神状态检查表一致。
LAAO相关的SCE与术后立即出现的明显认知功能损害相关，且在1年随访期间不可逆转。LAAO术后随访期间新的磁共振检测到的SCE也与认知功能下降相关。
