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

Thomas C Hanff; David M Kaye; Christopher S Hayward; Martijn C Post; Filip Malek; Gerd Hasenfuβ; Finn Gustafsson; Daniel Burkhoff; Sanjiv J Shah; Sheldon E Litwin; Rami Kahwash; Scott L Hummel; Barry A Borlaug; Scott D Solomon; Carolyn S P Lam; Jan Komtebedde; Frank E Silvestry;
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.
ISSN 1879-1913
Published 15 Dec 2019
Volume 124
Issue 12
Pages 1912-1917
DOI 10.1016/j.amjcard.2019.09.019
Type Journal Article