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Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve

E Mara Vollema1, William K F Kong1,2, Spyridon Katsanos1,3

  • 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

European Heart Journal
|April 4, 2017
PubMed

Insights

Hypo-attenuated leaflet thickening (HALT) on MDCT was present in 12.5% of patients post-TAVR, but rarely correlated with abnormal echocardiography. Neither HALT nor increased gradients predicted stroke or TIA, suggesting limited clinical utility for these markers.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Hypo-attenuated leaflet thickening (HALT) and reduced leaflet motion on multi-detector row computed tomography (MDCT) are potential indicators of early TAVR valve thrombosis.
  • The association of these imaging findings with echocardiographic hemodynamic abnormalities and clinical outcomes like stroke remains unclear.

Purpose of the Study:

  • To determine the prevalence of HALT and/or reduced leaflet motion on MDCT in TAVR patients.
  • To assess the correlation between MDCT findings and abnormal valve hemodynamics on echocardiography.
  • To evaluate the association of these markers with the occurrence of ischemic stroke or transient ischemic attack (TIA).

Main Methods:

  • A cohort of 434 patients who underwent TAVR was evaluated.
  • MDCT was performed in 128 patients to assess for HALT and/or reduced leaflet motion.
  • Echocardiography was used to assess transvalvular gradients and aortic valve area (AVA) at multiple time points post-TAVR.
  • Clinical follow-up data was collected to record stroke/TIA events.

Main Results:

  • HALT and/or reduced leaflet motion was observed on MDCT in 12.5% of the evaluated patients.
  • These MDCT findings were associated with slightly higher mean transvalvular gradients and smaller AVA on echocardiography.
  • Only one patient with HALT on MDCT showed abnormal valve hemodynamics on echocardiography; neither marker was linked to an increased risk of stroke/TIA.

Conclusions:

  • HALT or reduced leaflet motion on MDCT is present in a subset of TAVR patients but infrequently corresponds to abnormal valve hemodynamics on echocardiography.
  • Neither MDCT-detected HALT nor increased transvalvular gradients were found to be predictive of stroke or TIA in this cohort.
  • The clinical significance of HALT and abnormal valve hemodynamics in predicting adverse events post-TAVR requires further investigation.
Abstract

Keywords:
EchocardiographyMulti-detector row computed tomographyStrokeThrombosisTranscatheter aortic valve replacement

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