Abstract 15897: Identification of Candidates for Novel Interatrial Shunt Devices Through Non-invasive Testing in Patients With Heart Failure and Preserved Ejection Fraction

Abstract

Introduction: Interatrial shunt devices (IASD) are a novel therapeutic option for heart failure and preserved ejection fraction (HFpEF). IASDs work by decompressing the overloaded left atrium (LA) via shunting of blood to the right atrium (RA). Thus, optimal candidates for the IASD intervention will have an elevated pressure gradient between the LA and RA. We hypothesized that increased LA-RA gradient could be diagnosed non-invasively by echo. Methods: A total of 293 consecutive patients with HFpEF who also underwent invasive hemodynamic testing were were identified. All patients underwent comprehensive echo, including tissue Doppler. Patients were categorized into 2 groups based on the LA-RA pressure gradient (PCWP-RA pressure) at time of invasive hemodynamic testing (PCWP-RAP > 10 mmHg [large pressure gradient] vs. PCWP 0-5 mmHg [low pressure gradient]), and clinical, laboratory, and echocardiography parameters were compared between groups. Results: Mean age was 64±12 years, 59% were female, 36% were African American, and comorbidities were common. Of the 293 patients, n=58 had PCWP-RAP gradient of 0-5 mmHg and n=114 had PCWP-RAP > 10 mmHg, with the rest of the patients (n=56) in the PCWP-RAP 5-10 mmHg range. Patients with an elevated PCWP-RAP gradient were more often female and obese and less likely to have a history of atrial fibrillation (Table). On echocardiography, the 2 parameters that were most different between groups were TAPSE and lateral e’ velocity such that an elevated ratio of TAPSE to lateral e’ velocity identified patients with HFpEF who were most likely to have an elevated PCWP-RAP gradient > 10 mmHg (area under the ROC curve = 0.69 [95% CI 0.60-0.78]; P=0.001). Conclusions: An elevated TAPSE/lateral e’ velocity ratio on echo in HFpEF is associated with invasive PCWP-RAP gradient > 10 mmHg at rest and may aid in the identifying suitable HFpEF candidates who would benefit from an IASD.