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Thrombus characterisation and evolution of hypoattenuating leaflet thickening after transcatheter aortic valve

Kajetan Grodecki1,2, Damini Dey1, Jolien Geers1,3

  • 1Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|May 6, 2025
PubMed

Insights

Quantitative computed tomography angiography (CTA) analysis of hypoattenuating leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) predicts HALT resolution and correlates with valve function. This aids in guiding oral anticoagulation therapy decisions.

Area of Science:

  • Cardiology
  • Radiology
  • Biomedical Engineering

Background:

  • Hypoattenuating leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) requires further understanding for clinical management.
  • Computed tomography angiography (CTA) offers a potential imaging modality for quantifying HALT and its implications.

Purpose of the Study:

  • To assess the association between quantitative CTA features of HALT and its temporal evolution post-TAVI.
  • To evaluate predictors of HALT resolution and progression in a real-world cohort.

Main Methods:

  • CTA analysis of 612 patients 30 days post-TAVI with balloon-expandable bioprostheses.
  • Prospective follow-up CTA at 1 year for 99 patients to assess HALT progression.
  • Quantitative assessment of thrombus volume, mean attenuation, and bioprosthetic deformation parameters.

Main Results:

  • HALT was detected in 19% of patients; complete resolution occurred in 43 patients.
  • Lower thrombus attenuation, eccentricity index, deformation index, and implant canting predicted HALT resolution.
  • Thrombus volume changes correlated with changes in transvalvular gradients, indicating impact on valve hemodynamics.

Conclusions:

  • Quantitative CTA characterization of HALT predicts its resolution after TAVI.
  • HALT evolution on CTA correlates with the hemodynamic performance of transcatheter aortic valves.
  • CTA-based quantitative thrombus assessment may inform oral anticoagulation therapy decisions post-TAVI.
Abstract

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