Associations of biomarkers with hypoattenuated leaflet thickening after transcatheter aortic valve replacement

Patients after transcatheter aortic valve replacement (TAVR) have a high incidence of hypoattenuating leaflet thickening (HALT). However, data on biomarkers related to HALT remain limited.

To identify hemostatic markers associated with HALT following TAVR.

This prospective single-center cohort study assessed hemostatic profiles of patients undergoing TAVR between November 2020 and June 2022 using thrombelastography, light transmission aggregometry, and conventional laboratory markers. The primary outcome was moderate-to-severe HALT (grade 3/4) or reduced leaflet motion (grade 2/3) detected by computed tomography angiography at 6 months post-TAVR.

Of the 107 patients included, 68 had interpretable computed tomography angiography at 6 months. The primary outcome occurred in 14 (20%) patients. Biomarkers were measured at a median of 4 days (IQR, 3-6) after TAVR. Shortened clot formation time (R-time with heparin neutralization) indicated an association with HALT at 6 months (odds ratio [OR], 1.12 [95% CI, 1.00; 1.25]; P = .05) and demonstrated moderate discriminatory ability, with an optimal cutoff of 4.9 minutes (sensitivity 79%; specificity 74%; area under the curve, 0.74 [95% CI, 0.60; 0.89]; P = .005). Increased platelet count (OR, 1.08 [95% CI, 1.01; 1.15]; P = .03), elevated protein S (OR, 1.21 [95% CI, 1.01; 1.44]; P = .04), and higher C-reactive protein levels (OR, 1.19 [95% CI, 1.00; 1.41]; P = .05) also demonstrated associations with HALT. However, after adjustment for multiple testing using the Benjamini-Hochberg procedure, none of these associations was statistically significant.

This exploratory study identified associations between HALT and biomarkers of hypercoagulability and inflammation, which did not persist after correction for multiple testing. These findings should be regarded as hypothesis-generating and warrant confirmation in future studies.