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Echocardiographic features of post-transcatheter aortic valve implantation thrombosis and endocarditis

Marco Spartera1, Francesco Ancona1, Marta Barletta1

  • 1Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Echocardiography (Mount Kisco, N.Y.)
|December 22, 2017
PubMed

Insights

Echocardiography can better diagnose transcatheter heart valve thrombosis (THV-t) after TAVI by combining Doppler and leaflet features. This improves specificity, aiding in appropriate patient management and avoiding unnecessary tests.

Area of Science:

  • Cardiology
  • Echocardiography
  • Medical Imaging

Background:

  • Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are known complications following transcatheter aortic valve implantation (TAVI).
  • Current definitions of transcatheter heart valve (THV) dysfunction primarily rely on Doppler-derived parameters (stenosis/regurgitation), often overlooking leaflet characteristics.

Purpose of the Study:

  • To assess the added diagnostic value of echocardiographic leaflet features compared to Doppler alone for suspected prosthetic valve complications.
  • To enhance the diagnostic accuracy for THV thrombosis and endocarditis post-TAVI.

Main Methods:

  • Analysis of 621 post-TAVI patients, identifying 128 with suspected valve complications.
  • Evaluation of traditional Doppler parameters and leaflet morpho-functional features at baseline and follow-up.
  • Categorization into THV thrombosis (13%), THV endocarditis (6%), and no definitive diagnosis (84%).

Main Results:

  • Doppler and leaflet parameters demonstrated high sensitivity (92%) but low specificity (32%-74%) for THV-t detection.
  • Combining a mean aortic pressure gradient ≥20 mmHg with leaflet thickening significantly increased specificity for THV thrombosis to 94%.
  • Echocardiographic diagnosis of THV endocarditis showed high specificity but limited sensitivity.

Conclusions:

  • Integrating Doppler and leaflet parameters improves echocardiographic diagnosis of THV thrombosis in post-TAVI patients with suspicious symptoms.
  • This combined approach enhances overall test specificity, potentially optimizing the use of advanced diagnostic imaging and treatments.
  • Improved diagnostic accuracy can lead to more judicious decisions regarding further investigations like CT scans or anticoagulation therapy.
Abstract

Keywords:
echocardiographyendocarditisthrombosistranscatheter aortic valve implantation (TAVI)

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