International journal of cardiology · 2025
Routine preoperative transthoracic echocardiography for predicting incomplete endothelialization of the watchman left atrial appendage occluder: A single-center five-year study.
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Yu Yichi, Yang Xiaomin, Sun Jian, Zhang Pengpai, Li Wei, Zhang Rui, Chen Mu, Zhao Mingzhe, Yang Yuli, Wang Ting, Wang Qunshan, Li Yigang
Аннотация
BACKGROUND & OBJECTIVES: Incomplete endothelialization of the left atrial appendage(LAA) occluder potentially affects the long-term efficacy of stroke prevention in atrial fibrillation(AF) patients. This study aims to explore the value of routine preoperative transthoracic echocardiography(TTE) in predicting the endothelialization of Watchman LAA occluder.
METHODS: This single-center retrospective study included 437 AF patients who underwent the LAA closure with Watchman 2.5 occluder from January 2017 to December 2022. Cardiac CTA was performed 3-6 months after the procedure. Based on contrast infiltration into the LAA cavity, two groups were defined as follows: completely and incompletely endothelialized. The baseline and pre-procedural TTE parameters were analyzed.
RESULTS: The average age was 70.2 years old, with 208 females(47.6 %). The incompletely endothelialized group had an older age (71.4 ± 7.5 vs 69.8 ± 7.6,p = 0.053), a larger left atrial(LA) diameter (44.0 ± 5.9 vs 42.7 ± 6.1 mm,p = 0.045) and a lower left ventricular ejection fraction(LVEF%)(62.5 ± 7.5 vs 63.0 ± 5.4 %,p = 0.016) than the completely endothelialized group. Univariate analysis revealed that incomplete endothelialization was associated with persistent AF(OR:1.68;95 % CI:1.08-2.10;p = 0.021), a higher LA diameter(OR:1.04;95 % CI:1.00-1.07;p = 0.046), a higher left ventricular diastolic diameter(LVDD)(OR:1.05;95 % CI:1.00-1.10;p = 0.032),and the presence of mild mitral stenosis (mean pressure gradient <5 mmHg and mitral valve area > 1.5 cm2,OR:11.29;95 % CI:1.25-102.10;p = 0.031), while it was negatively correlated with mild left ventricular diastolic dysfunction (OR:0.49;95 % CI:0.26-0.94;p = 0.033). Multivariate analysis demonstrated that mild mitral stenosis(OR: 13.79;95 % CI:1.37-139.13;p = 0.026) was an independent predictor for incomplete endothelialization.
CONCLUSION: Preoperative TTE may predict the outcomes of endothelialization after left atrial appendage occlusion. Mild or severe mitral stenosis is an independent predictive factor for poor endothelial coverage.
METHODS: This single-center retrospective study included 437 AF patients who underwent the LAA closure with Watchman 2.5 occluder from January 2017 to December 2022. Cardiac CTA was performed 3-6 months after the procedure. Based on contrast infiltration into the LAA cavity, two groups were defined as follows: completely and incompletely endothelialized. The baseline and pre-procedural TTE parameters were analyzed.
RESULTS: The average age was 70.2 years old, with 208 females(47.6 %). The incompletely endothelialized group had an older age (71.4 ± 7.5 vs 69.8 ± 7.6,p = 0.053), a larger left atrial(LA) diameter (44.0 ± 5.9 vs 42.7 ± 6.1 mm,p = 0.045) and a lower left ventricular ejection fraction(LVEF%)(62.5 ± 7.5 vs 63.0 ± 5.4 %,p = 0.016) than the completely endothelialized group. Univariate analysis revealed that incomplete endothelialization was associated with persistent AF(OR:1.68;95 % CI:1.08-2.10;p = 0.021), a higher LA diameter(OR:1.04;95 % CI:1.00-1.07;p = 0.046), a higher left ventricular diastolic diameter(LVDD)(OR:1.05;95 % CI:1.00-1.10;p = 0.032),and the presence of mild mitral stenosis (mean pressure gradient <5 mmHg and mitral valve area > 1.5 cm2,OR:11.29;95 % CI:1.25-102.10;p = 0.031), while it was negatively correlated with mild left ventricular diastolic dysfunction (OR:0.49;95 % CI:0.26-0.94;p = 0.033). Multivariate analysis demonstrated that mild mitral stenosis(OR: 13.79;95 % CI:1.37-139.13;p = 0.026) was an independent predictor for incomplete endothelialization.
CONCLUSION: Preoperative TTE may predict the outcomes of endothelialization after left atrial appendage occlusion. Mild or severe mitral stenosis is an independent predictive factor for poor endothelial coverage.