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

作者：Jaffar M. Khan, Toby Rogers, Ron Waksman, Rebecca Torguson, Gaby Weissman, Diego Medvedofsky, Paige Craig, Cheng Zhang, Paul Gordon, Afshin Ehsan, Sean R. Wilson, John Goncalves, Robert G. Levitt, Chiwon Hahn, Puja B. Parikh, Thomas V. Bilfinger, David Butzel, Scott Buchanan, Nazeeh Hanna, Robert Garrett, Christian Shults, Héctor M. García‐García, Paul Kolm, Lowell F. Satler, Maurice Buchbinder, Itsik Ben‐Dor, Federico M. Asch · 发表于：Circulation Cardiovascular Imaging · 年份：2019 · DOI：10.1161/circimaging.119.009608 · 被引用次数：43 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiovascular Function and Risk Factors、Atrial Fibrillation Management and Outcomes

Background: This analysis evaluated echocardiographic predictors of hypoattenuated leaflet thickening (HALT) in low-risk patients undergoing transcatheter aortic valve replacement and assessed 1-year clinical and hemodynamic consequences. HALT by computed tomography may be associated with early valve degeneration and increased neurological events. Methods: Echocardiograms were performed at baseline, discharge, 30 days, and 1 year post-procedure. Four-dimensional contrast-enhanced computed tomography assessed HALT at 30 days. Independent core laboratories analyzed images. Doppler hemodynamic parameters were tested in a univariable regression model to identify HALT predictors. One-year clinical and hemodynamic outcomes were compared between HALT (+) and (−) patients. Results: Analysis included 170 patients with Sapien 3 valves and diagnostic 30-day computed tomographies, of whom 27 (16%) had HALT. Baseline characteristics were similar between groups. After transcatheter aortic valve replacement, aortic flow was nonsignificantly reduced in patients who developed HALT. Regression analysis did not show significant association between baseline or discharge valve hemodynamics and development of HALT at 30 days. Patients with HALT had smaller aortic valve areas (1.4±0.4 versus 1.7±0.5 cm 2 ; P =0.018) and Doppler velocity index (0.4±0.1 versus 0.5±0.1; P =0.003) than those without HALT at 30 days but not at 1 year. There was no difference in aortic mean gradient at 30 days. There was...