Impact of left atrial appendage closure on circulating microvesicles levels: The MICROPLUG study. (15th May 2020)

• Record Type: Journal Article
• Authors: Amabile, Nicolas; Bagdadi, Imane; Armero, Sebastien; Elhadad, Simon; Sebag, Frederic; Landolff, Quentin; Saby, Ludivine; Mechulan, Alexis; Boulanger, Chantal M.; Caussin, Christophe
• Is Part Of: International journal of cardiology. Volume 307(2020)
• Page Start: 24
• Page End: 30
• Publication Date: 2020-05-15
• Subjects: LAA occlusion -- Circulating microvesicles -- Coagulation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.10.026
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation therapy for the prevention of systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Microvesicles (MVs) are shed-membrane particles generated during various cellular types activation/apoptosis that carry out diverse biological effects. LAA has been suspected to be a potential source of MVs during AF, but the effects its occlusion on circulating MVs levels are unknown. Methods: N = 25 LAAO and n = 25 control patients who underwent coronary angiography were included. Blood samples were drawn before and 48 h after procedure for all. A third sample was collected 6 weeks after procedure in LAAO patients. In N = 10 extra patients, samples were collected from right atrium, LAA and pulmonary vein during LAAO procedure. Circulating AnnV + procoagulant, endothelial, platelets, red blood cells/RBC and leukocytes derived-MVs were measured using flow cytometry methods. Results: In the LAAO group, AnnV+, platelets, RBC, and leukocytes MVs were significantly increased following intervention, whereas only AnnV + MVs levels significantly rose in controls. The 6-w analysis showed that RBC-MVs and AnnV + MVs levels were still significantly elevated compared to baseline values in LAAO patients. The in-site analysis revealed that leukocytes and CD62e + endothelial-MVs were significantly higher in left atrial appendage compared to pulmonary vein, suggesting a local increased production. No major adverse event was observed in any patient post procedural course. Conclusions: LAAO impacts circulating MVs and might create mild pro-coagulant status and potential erythrocytes activation due to the device healing during the first weeks following intervention. Highlights: LAAO intervention creates a transient increase in platelets and leukocytes microvesicles. AnnV+ and erythrocytes microvesicles are durably increased following LAAO. Coagulation status and erythrocytes activation are modified during the first weeks following LAAO.