The effect of left atrial appendage closure on heart failure biomarkers: A PRAGUE‐17 trial subanalysis

Abstract

Introduction The randomized PRAGUE‐17 trial demonstrated noninferiority of left atrial appendage closure (LAAC) to non‐vitamin K anticoagulants (NOACs) for the prevention of major cardiovascular or cerebrovascular events. However, the left atrial appendage is an important source of natriuretic peptides and plays a role in left atrial reservoir function. Changes of heart failure (HF) biomarkers after LAAC compared to NOAC has not been studied. The aim of the study was to compare the changes in concentrations of HF biomarkers between LAAC and NOAC patients. Methods Of 402 patients randomized in the PRAGUE‐17 trial, biomarkers were analyzed in 144 patients (73 in the NOAC and 71 in the LAAC group). Both groups had similar baseline characteristics. Serum concentration of NT‐proBNP, NT‐proANP, Galectin‐3, and GDF‐15 were measured at baseline (before the procedure in the LAAC group), at the 6‐month (and at 24‐month for NT‐proBNP) follow‐up timepoint. Results There were no significant differences in baseline, 6 month, and delta (δ = baseline − 6 month) concentrations of NT‐proANP between the groups (NOAC: baseline 2.6 [0.5; 4.9], 6‐month 3.1 [1.8; 4.8], p = .068; LAAC: baseline 3.3 [1.1; 4.6], 6‐month 2.6 [0.9; 5.3], p = .51; p value for δ in concentrations between groups = 0.42). Similarly, there were no significant differences in baseline, 6, 24 months, and delta concentrations of NT‐proBNP between the groups (NOAC: baseline 461.0 [113.5; 1342.0], 6 month 440.0 [120.5; 1291.5], 24 month 798 [274; 2236], p = .39; LAAC: baseline 421.0 [100.0; 1320.0], 6 month 601.0 [145.0; 1230.0], 24 month 855 [410; 1367], p = .28; p value for δ in concentrations between groups = 0.73 at 6 months, and 0.58 at 24 months). Finally, no significant differences were present in baseline, 6 month, and δ concentrations of Galectin‐3 and GDF‐15 between the two groups. Conclusion LAAC did not significantly influence the levels of HF biomarkers 6 months after the procedure.

Prognostic Value of Galectin-3 after Left Atrial Appendage Occlusion for Predicting Peri-Device Leakage

“…Also, the possible relationship between galectin-3 serum levels and LAAO has been addressed in a sub-analysis of the PRAGUE-17 trial. Here, no relevant differences could be shown when comparing the 6-month follow-up with the baseline [23].…”

Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice

“…On the other hand, there are several studies demonstrating that LAAO does not lead to any significant changes in natriuretic peptide levels at all [43,[49][50][51][52]. For instance, the abovementioned prospective randomized study PRAGUE-17 (400 patients) did not observe a difference in levels of natriuretic peptides between the LAAO and anticoagulated groups [53]. Similar outcomes have been observed after concomitant and standalone surgical LAAO [49,52].…”

Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure

“…LAAC also led to functional and structural remodeling of LA and LV, which might further facilitate the maintenance of AF and deterioration of HF [24]. Despite neutral effects on HF biomarkers, LAAC might lead to more frequent HF hospitalization, especially in patients with HF history [25].…”