Heart failure & cardiomyopathies
Left Atrial to Coronary Sinus Shunting in More Advanced Heart Failure with Preserved Ejection Fraction
Authors' conclusion
The quality-of-life, haemodynamic, and functional class improvements along with stable right heart function seen in ALT-FLOW study of LA-CS shunt remain consistent in the subgroup with highest NP levels. This suggests that shunting location could influence outcomes in symptomatic heart failure patients.
Study context
- Population
- Patients from the ALT-FLOW early feasibility study with left ventricular ejection fraction >40% and 1-year follow up, divided by natriuretic peptide levelsanalysis population
- Participants
- 95 patients
- Comparison
- High natriuretic peptide (NP) subgroup vs low NP subgroup after left atrial to coronary sinus (LA-CS) shunt; post-implant vs pre-implant baseline
- Outcome
- KCCQ-OSS and NYHA functional class
Main finding
As reported in the abstract
- High NP subgroup: significant improvements in KCCQ-OSS
- P < 0.0001
- High NP subgroup: significant improvements in NYHA functional class
- P < 0.001
Further findings
| Outcome | High NP subgroup | Low NP subgroup |
|---|---|---|
| Workload adjusted pulmonary artery wedge pressure at peak exercise (PCWL), pre-implant baseline vs 6 months | 164.1 vs. 96.0 mmHg/W/kg | 115.9 vs. 65.9 mmHg/W/keg |
- Workload adjusted pulmonary artery wedge pressure at peak exercise (PCWL), pre-implant baseline vs 6 months: high NP subgroup P < 0.003
- Workload adjusted pulmonary artery wedge pressure at peak exercise (PCWL), pre-implant baseline vs 6 months: low NP subgroup P < 0.001
Cardiac index and right ventricular structure and function · 6 months (cardiac index); 1 year (RV)
- In both NP subgroups, preservation of cardiac index through 6 months as well as right ventricular structure (right ventricular diastolic dimension) and function (tricuspid annular systolic plane excursion) through 1 year
Baseline characteristics of high NP subgroup
- Worse haemodynamic profiles, lower estimated glomerular filtration rate, and higher percentages of atrial fibrillation in the high NP subgroup
Original publication
Left Atrial to Coronary Sinus Shunting in More Advanced Heart Failure with Preserved Ejection Fraction. ESC Heart Fail. Published 16 March 2025. doi:10.
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