Acute and Short-Term Hemodynamic and Echocardiography Changes During and After Left Atrial Appendage Closure

Abstract

Background: The left atrial appendage (LAA) plays an important role as a reservoir and has endocrine functions. This study aimed to assess the acute hemodynamic effects associated with LAA closure (LAAC) and ensuing structural changes 3 months after closure. Methods: Two centers enrolled patients for LAAC from January 2022 to July 2024. Invasive hemodynamic measurements of left atrial pressure (LAP) were taken after the transseptal puncture and postdevice deployment (both before and after isometric exercise). The heart failure (HF) biomarkers (NT-proBNP, NT-proANP, and GDF-15) were assessed before and 3 months after LAAC. The echocardiographic parameters were assessed before and 6 months after LAAC. Results: Sixty-two patients participated (age 75.7 +- 8.2 years, 45 (72.6%) males, CHA<inf>2</inf>DS<inf>2</inf>VASc 4.1 +- 1.3). Both rest and postexercise LAP values increased after device implantation (rest: 14.9 +- 7.1 before vs. 17.6 +- 7.9 mm Hg after, p < 0.001; postexercise: 18.7 +- 8.6 before vs. 21.8 +- 9.5 mm Hg after, p < 0.001). The administration of larger volumes of fluid during the procedure was significantly correlated with a higher increase in resting LAP following device implantation. On the other hand, exercise-induced changes in postprocedural LAP (i.e., the difference between postexercise vs. rest) were negatively associated with the amount of fluid administered during the procedure. Three months postprocedure, we observed no changes in HF biomarkers. Six months postprocedure, we observed no changes in LA and LV echocardiographic parameters. Conclusions: LAAC caused an acute increase in both rest and exercise LAP. The amount of procedural fluid is one of the most important parameters associated with LAP changes.