Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-215 - Left Atrial Appendage Closure As A Predictor For Diastolic Heart Failure (ID 258)

Abstract

Background: Dyspnea with exertion (DOE) and exercise intolerance despite normal left ventricular function are the clinical manifestations diastolic HF (DHF). Elevated pulmonary capillary wedge pressure (PCWP), especially during exercise, is a hallmark finding with this debilitating hemodynamic derangement. Left atrial appendage (LAA) closure (LAAC) is an increasingly common treatment for patients with AF to mitigate stroke risk. However, exclusion of the LAA from the blood pool may have hemodynamic consequences related to LAA capacitance. A relationship between LAAC and diastolic dysfunction has not been previously elucidated.
Objective: We sought to determine the correlation between LAAC and PCWP in patients with DOE and preserved LVEF.
Methods: We retrospectively analyzed hemodynamic data from right heart catheterization with exercise for 72 patients with DOE. We then compared PCWP at baseline and peak exertion for patients with and without LAAC and AF.
Results: For our cohort of patients with exertional dyspnea, those with LAAC demonstrated significantly elevated PCWP both at rest and exercise. This elevation was higher than that seen with AF history alone.
Conclusion: DHF is common in patients with AF. To our knowledge, the contribution of LAA closure to this hemodynamic derangement has not been previously investigated. It is possible, given our findings of further PCWP elevation with LAAC in this subset of patients, that closure may contribute to these findings. These findings are preliminary and should motivate further systemic investigation into the relationship of LAA and its closure to symptomatic DHF in order to better understand the hemodynamic implications of LAAC.
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