Perkütan Sol Atriyal Apendiks Kapatmanın Diyastolik Işlevler Üzerinde Etkisinin Araştırılması

Abstract

Left atrial appendage (LAA) is the main source of left atrial thrombus that causes stroke in patients with non-valvular atrial fibrillation (AF). Diastolic dysfunction is highly prevalent in patients with atrial fibrillation. The importance of echocardiography in the diagnosis of diastolic dysfunction is well known. In addition, Brain Natriuretic Peptide (BNP) is used as a marker of diastolic dysfunction. The aim of this study was to investigate how the impact of Percutaneous Left Atrial Appendage Closure on left ventricular (LV) diastolic function parameters assessed by echocardiography and BNP levels as a marker of diastolic function in AF patients who are in high-risk group and with contraindication for anticoagulation treatment. Twelve non-valvular AF patients [9 males (75%), mean age 69.0±7.0 years] with high risk for developing cardioembolic stroke (CHA2DS2VASc score = 3.5 ± 1.4) and contraindications to warfarin underwent LAA occlusion with the WATCHMAN System (Atritech Inc., Plymouth, Minnesota) from May 2010 to October 2011. Routine transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) was performed to patients 1 day before and 45 days after treatment according to the protocol. Along with routine systolic and diastolic parameters (eg., E wave velocity, diameters of chambers, EF) parameters derived from mitral inflow and pulmonary venous flow velocities such as deceleration time (DT), flow index of propagation velocity (Vp), IVRT , TE-E ', IVRT / TE-E', E / Vp, E / E?, E? wave of right ventricle, septum, lateral, inferior and anterior wall measured by tissue Doppler , pulmonary vein flow paramaters consisting of S, D and DT, S / D were evaluated by TTE and TEE 1 day before and 45 days after treatment in these patients. BNP levels were evaluated one day before and 45 days after the treatment. Patients were followed by clinical, transthoracic and transesophageal echocardiography at 45 days and 6 months with annual clinical follow-up thereafter.The LAA was successfully occluded in 12/12 patients (100%). The mean procedural and fluoroscopic times were 55.0 ± 8.1 minutes and 18 ± 5.2 minutes, respectively. The mean size of implanted device was 25.5±3.9 mm. The average hospital stay was 2.0±0.9 days. Follow-up TEE showed all the LAA orifices were sealed without device-related thrombus formation. No stroke or death occurred at a median follow-up of 72 (interquartile range= 49-176) days. Total amount of minor adverse events was 4 (33.3%) observed after the procedure. E/Vp(pre-processing median 1.95 vs. post-processing median 2.37, p <0.05) and BNP(The median pre-processing 290.0 versus 322.0 median after the procedure, p <0.05) levels were increased and S/D(pre-processing median 1.62 versus median post-process 1.33, p <0.05) and PVS(pre-processing median 0.67 versus median after the operation was 0.38, p <0.05) levels were decreased after the procedure. The positive correlation between increase in percentage change of BNP levels with increase in percentage change in EVP'deki (r = 0598, p = 0.040) and negative correlation between increase in percentage change of BNP levels with decrease in percentage change of S/D levels (r=-0.586, p=0.045) was detected. In conlusion,our initial experience suggested LAA closure with WATCHMAN system is safe, feasible with favorable short-term clinical outcomes. Patients with AF have shown adversely affected diastolic functions after the percutaneous closure of the LAA in this study.