Heart failure & cardiomyopathiesResearch article
The ALT FLOW early feasibility study 3-year results assessing left atrial to coronary sinus shunting in HFpEF
- Early Feasibility Study
Authors' conclusion
In patients with HF and LVEF >40%, the APTURE LA-to-CS shunting confirmed an acceptable safety profile with stable right heart parameters and sustained improvements in symptoms, quality of life, and functional capacity at 3 years. Observed survival and HFH were superior to MAGGIC predictions.
Study context
- Population
- Patients with heart failure and left ventricular ejection fraction (LVEF) > 40% treated with left atrial-to-coronary sinus (LA-to-CS) shunting through the APTURE transcatheter shunt systempatients with LVEF > 40%
- Participants
- 95 patients
- Comparison
- MAGGIC score predicted 3-year all-cause mortality was compared with observed mortality assessed by Kaplan-Meier analysis using adjudicated events
Main finding
As reported in the abstract
Safety profile and shunt patency · 3 years
- Safety profile remained stable with no new safety signals
- All implanted shunts remained patent
Further findings
HFH-free survival · 3 years · observed HFH-free survival higher
P < 0001
| Outcome | Observed | MAGGIC-predicted | P value |
|---|---|---|---|
| 3-year survival · observed survival significantly higher | 84.4% | 70.2 | P & .009 |
NYHA class improvement by at least one class · 3 years
- Patients improved by at least one NYHA class
- 76.3%
KCCQ Overall Summary Score change from baseline · 3 years
- Mean increase from baseline
- 25 points
- P
- P < 0.0001
6-min walk distance change · 3 years
- Average improvement
- 39 m
- P
- P & .002
- These benefits were consistent regardless of baseline pulmonary vascular resistance (PVR)
Right heart echocardiographic parameters · 3 years
- Right heart echocardiographic parameters stable
- Reduction in TAPSE observed, primarily in the high PVR subgroup
Original publication
The ALT FLOW early feasibility study 3-year results assessing left atrial to coronary sinus shunting in HFpEF. ESC Heart Fail. Published 12 March 2026. doi:10.1093/eschf/xvag070
Summarised from the published abstract; every number is checked against it