Improvement in Left Atrial Strain among Patients Undergoing Percutaneous Left Atrial Appendage Closure

Shun Ijuin; Ali Hamadanchi; Franz Haertel; Laura Baez; Paul Christian Schulze; Marcus Franz; Sven Moebius-Winkler

doi:10.4103/jcecho.jcecho_42_19

Improvement in Left Atrial Strain among Patients Undergoing Percutaneous Left Atrial Appendage Closure

J Cardiovasc Echogr. 2020 Jan-Mar;30(1):15-21. doi: 10.4103/jcecho.jcecho_42_19. Epub 2020 Apr 13.

Authors

Shun Ijuin^{1

2}, Ali Hamadanchi¹, Franz Haertel¹, Laura Baez¹, Paul Christian Schulze¹, Marcus Franz¹, Sven Moebius-Winkler¹

Affiliations

¹ Department of Internal Medicine I, Jena University Hospital, Jena, Germany.
² Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

Abstract

Background: Various clinical trials provide evidence about the safety, effectiveness, and therapeutic success of percutaneous left atrial appendage closure (LAAC) using various occlusion devices. These devices are foreign materials implanted into the left atrium and may deteriorate left atrial (LA) function. The aim of this study was to evaluate the change in transesophageal echocardiography (TEE)-derived LA strain after LAAC.

Methods and results: The study included 95 patients (age: 75 ± 6.7 years, 67% male) who underwent percutaneous LAAC. LA strain was evaluated at three different time intervals by TEE (baseline, 45 days, and 180 days after the procedure). All data were analyzed using the software Image-Arena (TomTec^®). Seventy patients had atrial fibrillation, whereas 25 were in sinus rhythm at baseline and during follow-up. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segments of the lateral wall in mid-esophageal four-chamber view. PACS was obtained in patients with sinus rhythm during examinations. Compared to baseline, PALS increased at 45 days after the procedure (12.4% ± 8.4% at baseline vs. 16.0% ± 10.6% after 45 days, P = 0.001) and remained stable from 45 days to 180 days after procedure (13.8% ± 9.1% after 45 days vs. 17.2% ± 12.6% after 180 days, P = 0.092). Similarly, PACS increased at 45 days after the procedure (5.8% ± 3.9% at baseline vs. 10.6% ± 7.6% after 45 days, P = 0.001) and remained stable from 45 days to 180 days after the procedure (7.6% ± 4.5% after 45 days vs. 7.9% ± 3.1% after 180 days, P = 0.876).

Conclusions: Our study demonstrated for the first time the improvement in TEE-derived LA strain following LAAC within 45 days of implantation. The findings suggest improved LA function following LAAC.

Keywords: Peak atrial contraction strain; peak atrial longitudinal strain; percutaneous left atrial appendage closure; transesophageal echocardiography.