{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:15:29Z","timestamp":1788988529108,"version":"build-2803163510"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,9,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Left atrial appendage (LAA) closure (LAAC) could prevent stroke in patients with atrial fibrillation. However, LAAC may impair the compliance of the left atrium and result in poor prognosis. This study aimed to comparatively evaluate the prognosis of LAAC among patients with different sizes of LAA orifice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Three hundred two consecutive patients who underwent successful LAAC were included and divided into 4 groups based on LAA orifice size that was measured using transesophageal echocardiography. Clinical outcomes including thromboembolic events, major cardiocerebrovascular adverse events, and acute heart failure (AHF) were compared among 4 quartile groups and between propensity\u2010score matched groups of large and small LAAs. Through follow\u2010up of 39.6\u00b18.4\u2009months, survival of thromboembolic events was similar. Survival of major cardiocerebrovascular adverse events was significantly lower in the group with the largest LAA orifice (log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), including a higher incidence of AHF with New York Heart Association class III to IV (21.4%, log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              =0.009). A large LAA orifice (by cutoff) could predict major cardiocerebrovascular adverse events (hazard ratio, 3.749 [95% CI, 2.074\u20136.779]) in most patients, except for subgroups of those aged &lt;65\u2009years, with paroxysmal atrial fibrillation, and\/or with failed rhythm\/rate control. Further compared with a propensity\u2010score matched small\u2010LAA group, the large\u2010LAA orifice group still presented worse survival of AHF with New York Heart Association class III to IV (log\u2010rank\n              <jats:italic>P<\/jats:italic>\n              =0.010).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with a larger LAA orifice presented a worse prognosis after LAAC, including a higher incidence of AHF. A large LAA orifice could predict a post\u2010LAAC AHF event in most patients, except for young patients, patients with paroxysmal atrial fibrillation, and\/or with failed rhythm\/rate control.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04185142.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026309","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T09:38:42Z","timestamp":1663148322000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Patients With Larger Left Atrial Appendage Orifice Presented Worse Prognosis Contributed by Acute Heart Failure After Left Atrial Appendage Closure"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7592-7597","authenticated-orcid":false,"given":"Zhongyuan","family":"Ren","sequence":"first","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixing","family":"Zheng","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haotian","family":"Yang","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayu","family":"Wu","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailing","family":"Li","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1323-5450","authenticated-orcid":false,"given":"Rong","family":"Guo","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weilun","family":"Meng","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6074-2792","authenticated-orcid":false,"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Sun","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yawei","family":"Xu","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2647-6782","authenticated-orcid":false,"given":"Dongdong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Heart Center, Shanghai Tenth People\u2019s Hospital, School of Medicine Tongji University Shanghai 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