Efficacy and safety of percutaneous left atrial appendage closure in chronic kidney disease patients with atrial fibrillation : results of a 7-year registry

SP061 EFFICACY AND SAFETY OF PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE IN CHRONIC KIDNEY DISEASE PATIENTS WITH ATRIAL FIBRILLATION: RESULTS OF A 7YEAR REGISTRY Miguel Bigotte Vieira 1 , Miguel Nobre Menezes 2 , Ana Rita Francisco 2 , Cl audia Jorge 2 , Pedro Carrilho Ferreira 2 ,Lu  ıs Carpinteiro 2 , Eduardo Infante de Oliveira 2 , Pedro Canas da Silva 2 , Ant onio Gomes da Costa 1 , Fausto J. Pinto 2 1 Nephrology and Renal Transplantation Department Santa Maria University Hospital (CHLN) Lisbon Portugal and 2 Cardiology Department Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center, CCUL Lisbon Portugal INTRODUCTION AND AIMS: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, the most devastating complication being thromboembolism leading to fatal or disabling stroke. Although oral anticoagulation (OAC) is the mainstay of prevention therapy in the general population, its benefit in chronic kidney disease (CKD) patients is less well defined. End-stage renal disease patients treated with vitamin K antagonists present increased risk of bleeding, accelerated cardiovascular calcification and increased risk of calciphylaxis. Left atrial appendage closure (LAAC) is performed to prevent complications in high-risk AF patients with contraindications to OAC and in AF patients with events despite OAC. AIM: To evaluate the efficacy and safety of LAAC in CKD patients with AF. METHODS: Single-center registry of consecutive patients submitted to percutaneous LAAC. All patients underwent a standardized clinical follow-up. The procedure details, complications, CHA2DS2-VASc and HAS-BLED scores were registered. We used the PROTECT-AF trial efficacy composite endpoint defined as the occurrence of stroke, cardiovascular death or systemic embolic events, and the same trial’s composite safety endpoint defined as the occurrence of procedure-related complications and major bleeding events. CKD patients were defined as patients with estimated glomerular filtration rate below 60 ml/min/1.73 m2 (using chronic kidney disease epidemiology collaboration equation). Statistical analysis included Mann-Whitney U test, chi-square test, Cox univariate analysis and Kaplan-Meier survival analysis. RESULTS: 92 patients were included (mean age 73 67 years, 59 male patients, 39 CKD patients). CKD patients presented statistically significant higher age (mean age 75 66vs7267; p=0.02), higher CHA 2 DS 2 -VASc score (mean score 4.7 61.3 vs 3.9 6 1.3; p=0.007) and higher HAS-BLED score (3.6 60.7 vs 3.2 60.8; p = 0.047) than non-CKD patients. During a mean follow-up of 959 6752 days, there were 3 strokes in 3 patients (1 CKD patient; 2 non-CKD patients), 7 deaths (all non-cardiovascular) and no additional systemic embolic events. Thus, the primary efficacy endpoint occurred in 3 patients. Considering the primary safety endpoint, there were 3 pericardial tamponades and 2 major bleeding in 5 patients (2 CKD patients, 3 non-CKD patients). Thus, the primary safety endpoint occurred in 5 patients. The presence of CKD did not predict the occurrence of the efficacy endpoint (p = 0,86) nor safety endpoint (p = 0,79) using Cox univariate analysis. There were no statistically significant differences between CKD and non-CKD patients regarding either safety (Log Rank 0.065, p=0.79) or efficacy endpoints (Log Rank 0.03, p =0.86). CONCLUSIONS: Percutaneous LAAC in CKD patients presented, in our cohort, similar outcomes to non-CKD patients. The procedure can be considered as a treatment option in this population. SP062 ASSOCIATION BETWEEN EARLY IMPARMENT IN RENAL FUNCTION AND CHANGES IN CARDIAC STRUCTURE AND FUNCTION Liana Xhakollari 4,2 , Margre´tLe osd ottir 2,3 , Martin Holzmann 1 , Peter Nilsson 2 , Anders Christensson 4,2 1 Medicine Karolinska University Hospital Stockholm Sweden, 2 Clinical Sciences Lund University Malmo¨ Sweden, 3 Cardiology Ska˚ne University Hospital Malmo¨ Sweden and 4 Nephrology Ska˚ne University Hospital Malmo¨ Sweden INTRODUCTION AND AIMS: Mild to moderate renal impairment affects 10% of the population but it is difficult to detect because the disease is usually asymptomatic. Patients with chronic kidney disease have an increased risk of myocardial infarction, heart failure and death. Patients with severe renal dysfunction often have changes in the structure and function of the heart. Previous reports show that also early renal dysfunction is a risk factor for cardiovascular death, but it is unknown if the changes in cardiac structure and function already exist in early impairment of renal function. The study aims to investigate if there is an early link between kidney disease and cardiac structural and/or functional changes. METHODS: The population was selected from Malmo¨ Preventive Project Reexamination-study (MPP-RES). 1792 participants with mean age 67 66 were examined in 2002-2006 with echocardiography. Among other variabels we measured left ventricular ejection fraction (LVEF), left atrial area indexed for body surface area (LAA/BSA), peak myocardial velocity of the basal left ventricular wall in early (Em or e´) and late (Am or  a) diastole in the lateral and septal walls and doppler measurement of peak velocity of blood flow through the mitral valve in early (Mitralis Emax) and late (Mitralis Amax) diastole. Cystatin C was analysed in plasma and estimated glomerular filtration rate (eGFR) with CKD-EPI formula was calculated. General linear regression was used for statistical analyses. We included 1504 of the participants with no prior history of heart failure (HF), EF =>40% and eGFR based >15 ml/min/1,73m2. The participants were then divided in 6 groups based on e-GFR levels =>90; 75-89,9; 60-74,9; 4559,9; 30-44,9; 15-29,9. 11,1 % av participants had eGFR =>90; 26,5% eGFR 75-89,9; 34,6% eGFR 60-74,9; 20,8% eGFR 45-59,9; 6,4% eGFR 30-44,9; 0,5% eGFR 15-29,9. 29,9% of the participants were women and 70,1% were men. We studied correlations between e-GFR groups and echocardiography parameters (mean values from lateral and septal walls). All analyses were adjusted for age, gender, hypertension, diabetes and medication with renin angiotensin inhibitors. We looked at the whole group and performed a subgroup analysis based on gender. RESULTS: A significant correlation between eGFR groups and LAA/BSA, Mitralis Amax and E/e´, respectively, was found in the total cohort (p=0,003, p=0.037 and p=0.022). This correlation remains significant among men but not among women. CONCLUSIONS: A significant correlation between early impairment of renal function and functional and structual echocardiographic markers of early diastolic dysfunction was observed. This supports our hypothesis that interaction between the heart and kidney exists even in the early stages av renal impairment. SP061 Figure Nephrology Dialysis Transplantation Abstracts doi:10.1093/ndt/gfx140 | iii125 Downloaded from https://academic.oup.com/ndt/article-abstract/32/suppl_3/iii125/3852997 by Faculdade de Medicina de Lisboa user on 29 November 2019