Prevalence and Clinical Outcomes of Left Atrial Appendage Filling Defect in Patients Undergoing Transcatheter Aortic Valve Replacement

Background: We sought to determine the prevalence and prognostic impact of left atrial appendage filling defect (LAAFD) presence by cardiac computed tomography angiography (CCTA) imaging prior to transcatheter aortic valve replacement (TAVR).

Methods: In a prospective single center study, CCTA scans were examined for the presence of LAAFD in 562 consecutive TAVR candidates. Study endpoints consisted of in-hospital and 1-year mortality. Multivariate models included clinical and demographic features, left ventricle ejection fraction (LVEF), frailty score, Society of Thoracic Surgeons (STS) score and periprocedural laboratory test results.

Results: The point prevalence of LAAFD on CCTA was 8.5% (n=48) in the entire cohort and 23.6% (n=36) and 2.9% (n=12) in patients with and without atrial fibrillation, respectively (HR=5.8, p<0.001). Anticoagulation was prescribed upon discharge to 58.3% of patients with LAAFD. In-hospital mortality rates in patients with versus those without LAAFD were 4.2% vs. 2.7%, respectively (p=0.56). One-year mortality rates in patients with LAAFD compared to patients without LAAFD were 10.4% vs. 8.2%, respectively (p=0.56).

Conclusion: Evidence of LAAFD in patients considered for TAVR is quite common, particularly among patients with atrial fibrillation. LAAFD might influence clinical outcomes in these patients. Therefore, evidence of LAAFD should be systematically sought in TAVR candidates undergoing preparatory CCTA, and, in its presence, anticoagulation should be considered.