The effect of an inter-atrial communication in the treatment of the patients with heart failure with mildly reduced and preserved ejection fraction - current state of knowledge

An elevated left atrial pressure at rest and especially at stress is the main cause of symptoms and an increased risk of hospitalization and death in patients with heart failure. The mechanistic approach with implantation of interatrial shunt device (IASD) to reduce left atrial pressure in the patients with heart failure with mildly reduced and preserved ejection fraction was feasible and safe in a pilot study. In a non-randomized REDUCE LAP-HF and a randomized REDUCE LAP-HF I study the implantation of IASD was associated with improved symptoms and hemodynamic parameters. The effect of IASD on the risk of cardiovascular events including death and risk of heart failure hospitalizations was the objective of a multicentric randomized sham procedure controlled REDUCE LAP-HF II study. The review article is focused on the rationale of the method and the results of essential studies.