Clinical impact of left atrial appendage filling defects in patients undergoing transcatheter aortic valve implantation.

Okuno, Taishi; Lanz, Jonas; Stortecky, Stefan; Heg, Dik; Bernhard, Benedikt; Gräni, Christoph; Huber, Adrian Thomas; Praz, Fabien Daniel; Räber, Lorenz; Valgimigli, Marco; Siontis, Georgios; Windecker, Stephan; Pilgrim, Thomas (2022). Clinical impact of left atrial appendage filling defects in patients undergoing transcatheter aortic valve implantation. European heart journal - cardiovascular imaging, 23(10), pp. 1354-1364. Oxford University Press 10.1093/ehjci/jeab142

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AIMS

Incidental detection of left atrial appendage (LAA) filling defects is a common finding on multi-detector computed tomography in aortic stenosis patients under evaluation for transcatheter aortic valve implantation (TAVI). We aimed to investigate the incidence of LAA filling defects before TAVI and its impact on clinical outcomes.

METHODS AND RESULTS

In a prospective registry, LAA filling defects were retrospectively evaluated and categorized into one of four sub-types: thrombus-like, heterogeneous, horizontal, and Hounsfield Unit (HU)-run-off. The primary endpoint was the composite of cardiovascular death or disabling stroke up to 1-year follow-up. Among 1621 patients undergoing TAVI between August 2007 and June 2018, LAA filling defects were present in 177 patients (11%), and categorized as thrombus-like in 22 (1.4%), heterogeneous in 37 (2.3%), horizontal in 80 (4.9%), and HU-run-off in 38 (2.4%). Compared to patients with normal LAA filling, patients with LAA filling defects had greater prevalence of atrial fibrillation (84.7% vs. 26.4%, P < 0.001) and history of cerebrovascular events (16.4% vs. 10.9%, P = 0.045). The primary endpoint occurred in 131 patients (9.2%) with normal LAA filling and in 36 patients (21.2%) with LAA filling defects (P < 0.001). Subgroup analysis suggested that the risk of disabling stroke was greatest in the thrombus-like pattern (23.0%), followed by the HU-run-off (8.0%), the heterogeneous (6.2%), and the horizontal pattern (1.2%).

CONCLUSION

LAA filling defects were observed in 11% of aortic stenosis patients undergoing TAVI and associated with an increased risk of cardiovascular death and disabling stroke up to 1 year following TAVI.

TRIAL REGISTRATION

https://www.clinicaltrials.gov. NCT01368250.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

 Okuno, Taishi, Lanz, Jonas, Stortecky, Stefan, Heg, Dierik Hans, Bernhard, Benedikt, Gräni, Christoph, Huber, Adrian Thomas, Praz, Fabien Daniel, Räber, Lorenz, Valgimigli, Marco, Siontis, Georgios, Windecker, Stephan, Pilgrim, Thomas

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 2047-2412

Publisher:

 Oxford University Press

Language:

 English

Submitter:

 Maria de Fatima Henriques Bernardo

Date Deposited:

 07 Sep 2021 15:56

Last Modified:

 20 Feb 2024 14:15

Publisher DOI:

 10.1093/ehjci/jeab142

PubMed ID:

 34463717

Uncontrolled Keywords:

 aortic valve atria atrial appendage thrombus defect implantation l fibrillation left left atrial appendage filling replacement stroke transcatheter transcatheter aortic valve

BORIS DOI:

 10.48350/159137

URI:

 https://boris.unibe.ch/id/eprint/159137

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