Abstract
ObjectivesTo investigate whether inflammatory and growth factors (IGFs) were associated with incomplete device endothelialization (IDE) at 6 months after successful left atrial appendage closure (LAAC).BackgroundIDE after LAAC is correlated with device-related thrombus (DRT) formation and subsequent thromboembolic events. However, biomarkers for early detection of IDE remain lacking.MethodsPlasma levels of IGFs including basic fibroblast growth factor (bFGF), platelet derived growth factor (PDGF), stromal cell derived factor (SDF)-1a, transforming growth factor (TGF)-β1, vascular growth factor receptor-1 (VEGF-R1) and von Willebrand factor (vWF) were determined using ELISA kits in 55 consecutive patients with atrial fibrillation (AF) at 6 months after LAAC with Watchman devices. The status of device endothelialization was assessed by transesophageal echocardiography and cardiac CT.ResultsIDE and complete device endothelialization(CDE)were detected in 38 and 17 patients, respectively. Among the six IGFs, only plasma level of bFGF was significantly lower in patients with IDE compared to those with CDE (303.49 ± 246.84 vs. 556.31 ± 197.84 pg/ml, p < 0.001). C-statistics of plasma bFGF for discriminating patients with IDE from those with CDE was 0.785 (95 % CI: 0.663–0.907, p < 0.001), with a cut-off value of 440.52pg/ml (sensitivity 0.765; specificity 0.789). Multivariate logistic regression model showed that lower bFGF was an independent factor for IDE (OR: 11.752, 95 % CI: 2.869–48.144, P = 0.001). bFGF improved the classification of patients (NRI: 0.677,95 % CI: 0.320–1.033, p = 0.004).ConclusionsReduced plasma bFGF level confers an increased risk for IDE after LAAC. Further prospective studies are warranted to examine if bFGF could serve as a biomarker for IDE post LAAC.
Highlights
Left atrial appendage closure (LAAC) is recommended by the latest guidelines for stroke prevention in atrial fibrillation (AF) patients [1, 2]
Multivariate logistic regression model showed that lower basic fibroblast growth factor (bFGF) was an independent factor for incomplete device endothelialization (IDE) (OR: 11.752, 95 % confidence interval (CI): 2.869–48.144, P = 0.001). bFGF improved the classification of patients (NRI: 0.677,95 % CI: 0.320– 1.033, p = 0.004)
Further prospective studies are warranted to examine if bFGF could serve as a biomarker for IDE post LAAC
Summary
Left atrial appendage closure (LAAC) is recommended by the latest guidelines for stroke prevention in atrial fibrillation (AF) patients [1, 2]. (IDE) often occurs in humans, which could result in device-related thrombus (DRT) formation and subsequent thromboembolic clinical events [4,5,6,7]. Early detection of IDE is mandatory for adjusting antithrombotic strategies to prevent DRT formation. Transesophageal echocardiography (TEE) and cardiac CT are clinically used for assessing device endothelialization following LAAC [8,9,10,11,12]. Some individuals are intolerant to TEE and cardiac CT could increase the risk of contrast-induced nephropathy for patients with renal dysfunction, highlighting that certain accessible and clinically applicable blood biomarkers for diagnosing IDE after LAAC are strongly desirable. IDE after LAAC is correlated with device-related thrombus (DRT) formation and subsequent thromboembolic events.
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