Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes.

Autor:	Mesnier J; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Simard T; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA., Jung RG; Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Lehenbauer KR; Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA., Piayda K; CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany., Pracon R; Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland., Jackson GG; Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA., Flores-Umanzor E; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Faroux L; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Korsholm K; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Chun JKR; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Chen S; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Maarse M; Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands., Montrella K; Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA., Chaker Z; Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA., Spoon JN; International Heart Institute of Montana, Missoula, Montana, USA., Pastormerlo LE; Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy., Meincke F; Asklepios Klinik Altona, Hamburg, Germany., Sawant AC; Chandler Regional Medical Center, Chandler, Arizona, USA., Moldovan CM; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland., Qintar M; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA; Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan., Aktas MK; Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Branca L; Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Radinovic A; Arrhythmology Department, San Raffaele University Hospital, Milan, Italy., Ram P; Emory University Hospital, Atlanta, Georgia, USA., El-Zein RS; Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., Flautt T; Houston Methodist Hospital, Houston, Texas, USA., Ding WY; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Sayegh B; Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA., Benito-González T; Department of Cardiology, University Hospital of León, León, Spain., Lee OH; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea., Badejoko SO; Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA., Paitazoglou C; Cardiologicum Hamburg, Hamburg, Germany., Karim N; Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom., Zaghloul AM; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Agarwal H; Creighton University School of Medicine, Omaha, Nebraska, USA., Kaplan RM; Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA., Alli O; Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA., Ahmed A; Rush University Medical Center, Chicago, Illinois, USA., Suradi HS; Rush University Medical Center, Chicago, Illinois, USA., Knight BP; Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA., Alla VM; Creighton University School of Medicine, Omaha, Nebraska, USA., Panaich SS; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Wong T; Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom., Bergmann MW; Department of Cardiology, AK Altona, Hamburg, Germany., Chothia R; Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA., Kim JS; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea., Pérez de Prado A; Department of Cardiology, University Hospital of León, León, Spain., Bazaz R; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Gupta D; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Valderrábano M; Houston Methodist Hospital, Houston, Texas, USA., Sanchez CE; Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., El Chami MF; Emory University Hospital, Atlanta, Georgia, USA., Mazzone P; Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Adamo M; Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Ling F; Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Wang DD; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA., O'Neill W; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA., Wojakowski W; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland., Pershad A; Chandler Regional Medical Center, Chandler, Arizona, USA., Berti S; Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy., Spoon DB; International Heart Institute of Montana, Missoula, Montana, USA., Kawsara A; Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA., Jabbour G; Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA., Boersma LVA; Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands., Schmidt B; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Nielsen-Kudsk JE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Freixa X; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Ellis CR; Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA., Fauchier L; Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France., Demkow M; Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland., Sievert H; Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA., Main ML; Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA., Hibbert B; Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Holmes DR Jr; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA., Alkhouli M; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: alkhouli.mohamad@mayo.edu., Rodés-Cabau J; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain. Electronic address: josep.rodes@criucpq.ulaval.ca.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2023 Nov 27; Vol. 16 (22), pp. 2722-2732.
DOI:	10.1016/j.jcin.2023.09.017
Abstrakt:	Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). Conclusions: About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT. Competing Interests: Funding Support and Author Disclosures Dr Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions (Laval University, Quebec City, Canada). He also has received institutional research grants from Boston Scientific. Dr Maarse has received an unrestricted grant from Boston Scientific. Dr Pérez de Prado has served as a proctor for Boston Scientific. Dr Gupta has served as a proctor for Abbott. Dr Sanchez has served as a speaker and proctor for Boston Scientific. Dr Wang has served as a consultant for Edwards Lifesciences, Boston Scientific, and Neochord; and received research grant support from Boston Scientific assigned to his employer, the Henry Ford Health System. Dr Demkow has served as a proctor for Abbott and Boston Scientific. Dr Alkhouli has served as a consultant for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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