Augustin Coisne1, Rosario Pilato2, François Brigadeau3, Didier Klug3, Christelle Marquie3, Zouheir Souissi3, Marjorie Richardson2, Stéphanie Mouton2, Anne-Sophie Polge2, Patrizio Lancellotti4, Dominique Lacroix3, David Montaigne5. 1. Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ. Lille, F-59000 Lille, France; INSERM UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France. Electronic address: augustincoisne@hotmail.com. 2. Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France. 3. CHU Lille, Clinique de Cardiologie, Lille, France. 4. University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy. 5. Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ. Lille, F-59000 Lille, France; INSERM UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France.
Abstract
BACKGROUND: Modifications in left atrial (LA) flow velocities after left atrial appendage (LAA) exclusion have been shown in animal and ex vivo models. In a substudy of PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation), an objective improvement in quality of life was observed after LAA closure. OBJECTIVE: The purpose of this study was to investigate the impact of LAA closure on LA transport function. METHODS: Comprehensive transthoracic echocardiography evaluation (2-dimensional [2D]/3-dimensional [3D], 2D speckle tracking) was prospectively performed before and after LAA closure (at discharge and 45 days after procedure) in 33 patients. RESULTS: LAA closure was associated with a significant improvement in LA reservoir function at discharge and 45 days after the procedure with (1) increased maximum LA volume index, (2) increased 2D-LA reservoir volume and expansion index, and (3) increased 2D speckle tracking-derived peak atrial longitudinal strain (PALS) (27.9 ± 14 and 26 ± 12.6 vs 21.7 ± 10.7%, P <.0001). LAA closure was also associated with a significant improvement in LA contractile function with (1) increased LA ejection fraction and (2) increased speckle tracking-derived peak atrial contraction strain (PACS) in sinus rhythm patients (19.1 ± 6.8 and 18.1 ± 5.4 vs 14.4 ± 6.4%, P = .0006). Conversely, the slope of the relation between PACS and PALS remained unchanged (0.5 ± 0.27 and 0.53 ± 0.3 vs 0.5 ± 0.25, P = .99), thus arguing for an improvement in LA contractile function secondary to a Frank-Starling effect rather than a modification in its intrinsic contractility. CONCLUSION: LAA closure was associated with an improvement in LA mechanical function. These changes appeared to be related to a modification in loading conditions, that is, a Frank-Starling effect.
BACKGROUND: Modifications in left atrial (LA) flow velocities after left atrial appendage (LAA) exclusion have been shown in animal and ex vivo models. In a substudy of PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation), an objective improvement in quality of life was observed after LAA closure. OBJECTIVE: The purpose of this study was to investigate the impact of LAA closure on LA transport function. METHODS: Comprehensive transthoracic echocardiography evaluation (2-dimensional [2D]/3-dimensional [3D], 2D speckle tracking) was prospectively performed before and after LAA closure (at discharge and 45 days after procedure) in 33 patients. RESULTS: LAA closure was associated with a significant improvement in LA reservoir function at discharge and 45 days after the procedure with (1) increased maximum LA volume index, (2) increased 2D-LA reservoir volume and expansion index, and (3) increased 2D speckle tracking-derived peak atrial longitudinal strain (PALS) (27.9 ± 14 and 26 ± 12.6 vs 21.7 ± 10.7%, P <.0001). LAA closure was also associated with a significant improvement in LA contractile function with (1) increased LA ejection fraction and (2) increased speckle tracking-derived peak atrial contraction strain (PACS) in sinus rhythmpatients (19.1 ± 6.8 and 18.1 ± 5.4 vs 14.4 ± 6.4%, P = .0006). Conversely, the slope of the relation between PACS and PALS remained unchanged (0.5 ± 0.27 and 0.53 ± 0.3 vs 0.5 ± 0.25, P = .99), thus arguing for an improvement in LA contractile function secondary to a Frank-Starling effect rather than a modification in its intrinsic contractility. CONCLUSION: LAA closure was associated with an improvement in LA mechanical function. These changes appeared to be related to a modification in loading conditions, that is, a Frank-Starling effect.
Authors: Shun Ijuin; Ali Hamadanchi; Franz Haertel; Laura Baez; Paul Christian Schulze; Marcus Franz; Sven Moebius-Winkler Journal: J Cardiovasc Echogr Date: 2020-04-13
Authors: Fabrizio Rosati; Gijs E de Maat; Mattia A E Valente; Massimo A Mariani; Stefano Benussi Journal: J Cardiovasc Electrophysiol Date: 2021-08-04 Impact factor: 2.942