Assessment of Predictors of Left Atrial Volume Response to a Transcatheter InterAtrial Shunt Device (from the REDUCE LAP-HF Trial)

TC Hanff, DM Kaye, CS Hayward, MC Post, F Malek, G Hasenfubeta, F Gustafsson, D Burkhoff, SJ Shah, SE Litwin, R Kahwash, SL Hummel, BA Borlaug, SD Solomon, CSP Lam, J Komtebedde, FE Silvestry
Am J Cardiol 2019

In patients with heart failure and preserved or mildly reduced ejection fractions (EF >/=40%), implantation of an interatrial shunt device (IASD) resulted in heterogenous changes of the left atrial (LA) volume. Baseline characteristics that correlate with a favorable decrease in LA volume are unknown. We hypothesized that a larger ratio of left to right atrial volume at baseline would correlate strongly with LA volume decongestion following IASD implantation. Reduce Elevated LA Pressure in Patients With Heart Failure was a multicenter study of the safety and feasibility of IASD implantation. Sixty-four patients with EF >/=40% underwent device implantation along with baseline conventional echocardiograms, speckle tracking echocardiography, and resting and exercise hemodynamics. Higher LA compliance (-4.2%, p=0.048) and right atrial reservoir strain (-0.8%, p=0.005) were independently associated with a percent decrease in the systolic LA volume index from baseline to 6-months. In conclusion, greater LA volume reduction following IASD implantation is associated with higher baseline compliance of the left atrium and higher reservoir strain of the right atrium.


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