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Hemodynamics and Subclinical Leaflet Thrombosis in Low-Risk Patients Undergoing Transcatheter Aortic Valve

Jaffar M Khan1,2, Toby Rogers1,2, Ron Waksman1

  • 1Section of Interventional Cardiology (J.M.K., T.R., R.W., R.T., P.E.C., C.Z., H.M.G.-G., P.K., L.F.S., I.B.-D.), Medstar Washington Hospital Center, DC.

Circulation. Cardiovascular Imaging
|December 13, 2019
PubMed

Insights

Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement was not predicted by early hemodynamics. Patients with HALT showed worse valve hemodynamics at 30 days, but 1-year outcomes were similar.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Radiology

Background:

  • Hypoattenuated leaflet thickening (HALT) identified by computed tomography after transcatheter aortic valve replacement (TAVR) may indicate early valve degeneration.
  • HALT has been linked to increased neurological events, necessitating further investigation into its predictors and consequences.

Purpose of the Study:

  • To evaluate echocardiographic predictors of HALT in low-risk patients undergoing TAVR.
  • To assess the 1-year clinical and hemodynamic outcomes in patients with and without HALT.

Main Methods:

  • Echocardiograms were collected at multiple time points (baseline, discharge, 30 days, 1 year).
  • Four-dimensional contrast-enhanced computed tomography was used to assess HALT at 30 days post-TAVR.
  • Univariable regression analysis identified potential HALT predictors, and outcomes were compared between HALT (+) and (-) groups.

Main Results:

  • Of 170 patients, 27 (16%) developed HALT. No significant association was found between baseline or discharge hemodynamics and HALT development.
  • At 30 days, HALT (+) patients had smaller aortic valve areas and lower Doppler velocity index compared to HALT (-) patients.
  • No significant differences were observed in aortic mean gradient, NYHA class, 6-minute walk distance, or mortality at 1 year.

Conclusions:

  • Early hemodynamic parameters do not predict the development of HALT post-TAVR.
  • While HALT is associated with worse valve hemodynamics at 30 days, it does not appear to impact 1-year clinical or hemodynamic outcomes in this low-risk cohort.
Abstract

Keywords:
aortic valveechocardiographyhemodynamicsregression analysistranscatheter aortic valve replacement

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