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Left Atrial Remodeling and Brain Natriuretic Peptide Levels Variation after Left Atrial Appendage Occlusion
Thibaut Pommier1,2, Thibault Leclercq1, Charles Guenancia1,2
1Department of Cardiology, University Hospital, 21000 Dijon, France.
Insights
The left atrial appendage occlusion (LAAO) technique may cause left atrial remodeling but does not significantly impact brain natriuretic peptide (BNP) levels during follow-up. Further studies are needed to correlate these findings with clinical outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Cardiac Imaging
Background:
- Limited data exist on brain natriuretic peptide (BNP) changes and left atrial remodeling post-left atrial appendage occlusion (LAAO).
- Understanding these effects is crucial for managing patients undergoing LAAO.
Purpose of the Study:
- To investigate variations in BNP levels and left atrial remodeling after LAAO.
- To assess the relationship between LAAO, reverse atrial remodeling (RAR), and BNP levels.
Main Methods:
- Prospective study of patients undergoing LAAO.
- Cardiac CT for LA volume assessment pre- and post-procedure.
- BNP measurements at baseline, 48 hours, and 30-45 days post-procedure.
Main Results:
- No significant difference in LA volume before and after LAAO.
- 14% of patients showed reverse atrial remodeling (RAR) at 6 weeks.
- BNP levels showed a slight transient increase at 48 hours in RAR patients, but were similar during follow-up.
Conclusions:
- LAAO can induce left atrial remodeling, but does not appear to affect long-term BNP levels.
- Clinical implications of these findings require further investigation in larger studies.
Background:
Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique.
Methods:
Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume >10%, together with blood sampling obtained before, 48 h after device implantation and at the first visit after discharge (30-45 days) for BNP measurement.
Results:
Among the 43 patients implanted with a complete dataset, mean end-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (p = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in the LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in six patients (14%). Despite no difference in BNP levels on admission, median BNP levels at 48 h were slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with two controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders.
Conclusion:
Our study showed that despite the fact that the LAAO technique can induce left atrial remodeling measured by a CT scan, it does not seem to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population in future studies.
