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Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement

Santiago Garcia1, Miho Fukui1, Marshall W Dworak1

  • 1Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.).

Circulation. Cardiovascular Interventions
|March 3, 2022
PubMed

Insights

Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) was identified in 12% of patients. This finding was independently associated with increased long-term mortality, highlighting a potential risk factor post-TAVR.

Area of Science:

  • Cardiology
  • Radiology
  • Interventional Cardiology

Background:

  • Hypoattenuated leaflet thickening (HALT) is a finding on cardiac computed tomography (CTA) that can impact valve function and patient outcomes.
  • The clinical significance of HALT in patients undergoing transcatheter aortic valve replacement (TAVR) requires further investigation.

Purpose of the Study:

  • To assess the impact of HALT on clinical outcomes in patients treated with TAVR.
  • To determine if HALT is associated with increased mortality after TAVR.

Main Methods:

  • Prospective screening for HALT using CTA at 30-day post-TAVR was implemented.
  • Patients with HALT were recommended anticoagulation with warfarin.
  • Outcomes including echocardiography, ischemic events, bleeding, and survival rates were compared between patients with and without HALT (HALT+ vs. HALT-).
  • Cox regression analysis identified independent predictors of long-term mortality.

Main Results:

  • Of 856 TAVR patients, 638 (75%) underwent CTA, with HALT identified in 79 (12.3%).
  • HALT+ patients were more likely prescribed warfarin and had similar valve gradients compared to HALT- patients.
  • After a median follow-up of 2.2 years, HALT+ patients exhibited increased mortality (30% vs. 20%; P=0.001).
  • HALT was independently associated with long-term mortality (hazard ratio, 1.83; P=0.014).

Conclusions:

  • HALT is present in approximately 12% of TAVR patients screened by CTA at 30 days.
  • The presence of HALT is independently associated with increased long-term mortality following TAVR.
  • These findings from an observational cohort require independent validation.
Abstract

Keywords:
survival ratetomographywarfarin

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