title: Percutaneous left atrial appendage closure improves left atrial mechanical function through Frank-Starling mechanism.
abstract: Modifications in left atrial (LA) flow velocities after left atrial appendage (LAA) exclusion have been shown in animal and ex vivo models. In a substudy of PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation), an objective improvement in quality of life was observed after LAA closure.
  
  
  
  The purpose of this study was to investigate the impact of LAA closure on LA transport function.
  
  
  
  Comprehensive transthoracic echocardiography evaluation (2-dimensional [2D]/3-dimensional [3D], 2D speckle tracking) was prospectively performed before and after LAA closure (at discharge and 45 days after procedure) in 33 patients.
  
  
  
  LAA closure was associated with a significant improvement in LA reservoir function at discharge and 45 days after the procedure with (1) increased maximum LA volume index, (2) increased 2D-LA reservoir volume and expansion index, and (3) increased 2D speckle tracking-derived peak atrial longitudinal strain (PALS) (27.9 ± 14 and 26 ± 12.6 vs 21.7 ± 10.7%, P <.0001). LAA closure was also associated with a significant improvement in LA contractile function with (1) increased LA ejection fraction and (2) increased speckle tracking-derived peak atrial contraction strain (PACS) in sinus rhythm patients (19.1 ± 6.8 and 18.1 ± 5.4 vs 14.4 ± 6.4%, P = .0006). Conversely, the slope of the relation between PACS and PALS remained unchanged (0.5 ± 0.27 and 0.53 ± 0.3 vs 0.5 ± 0.25, P = .99), thus arguing for an improvement in LA contractile function secondary to a Frank-Starling effect rather than a modification in its intrinsic contractility.
  
  
  
  LAA closure was associated with an improvement in LA mechanical function. These changes appeared to be related to a modification in loading conditions, that is, a Frank-Starling effect.
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ. Lille, F-59000 Lille, France; INSERM UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France. Electronic address: augustincoisne@hotmail.com.
authors.forename: Augustin
authors.initials: A
authors.lastname: Coisne
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France.
authors.forename: Rosario
authors.initials: R
authors.lastname: Pilato
authors.affiliation: CHU Lille, Clinique de Cardiologie, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: CHU Lille, Clinique de Cardiologie, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: CHU Lille, Clinique de Cardiologie, Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquie
authors.affiliation: CHU Lille, Clinique de Cardiologie, Lille, France.
authors.forename: Zouheir
authors.initials: Z
authors.lastname: Souissi
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Mouton
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Polge
authors.affiliation: University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.affiliation: CHU Lille, Clinique de Cardiologie, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Department of Echocardiography and Cardiovascular Explorations, CHU Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ. Lille, F-59000 Lille, France; INSERM UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France.
authors.forename: David
authors.initials: D
authors.lastname: Montaigne
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D011788:Quality of Life; D012039:Regional Blood Flow / Q000502:physiology; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Echocardiography; Mechanical function; Percutaneous left atrial appendage closure; Strain