The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement.
J Cardiovasc Comput Tomogr
; 16(2): 168-173, 2022.
Article
em En
| MEDLINE
| ID: mdl-34852974
ABSTRACT
BACKGROUND:
Hypo-attenuated leaflet thickening (HALT) may occur following transcatheter aortic valve replacement (TAVR), however, it remains unclear if HALT is a predictor of haemodynamic valve deterioration (HVD).AIM:
To determine the impact of HALT on the occurrence of HVD.METHODS:
We prospectively evaluated 186 patients for the presence of HALT at a median of 6 weeks following TAVR (Interquartile-range [IQR] 4-12 weeks). HALT depth and area were measured. HVD encompassed any of the following mean gradient ≥20 âmmHg with an increase in gradient ≥10 âmmHg from baseline, Doppler velocity index reduction ≥0.1 or new moderate-to-severe valvular regurgitation. Routine echocardiograms at discharge, one month and annually, were assessed by echo-cardiologists that were blinded to the HALT status.RESULTS:
LT prevalence was 17.7% (33/186). HVD was present in 8.6% (16/186) at a median follow-up of 2 years (IQR 1-3); two required valve re-intervention and five required anticoagulation. HALT was the only independent predictor of HVD on multivariate analysis (OR 33.3, 95%CI 7.4-125). Patients with HALT were more likely to develop HVD, require repeat valve intervention and have higher trans-valvular gradients at up to 3-year follow-up. Patients with HALT had a median cumulative thickness of 2.9 âmm (IQR 1.9-4.7) and area of 64.2 âmm2 (IQR 40.9-91.6). Thresholds for HALT in predicting HVD were a cumulative depth of 2.4 âmm (Specificity 94.1%, Sensitivity 75.0%, AUC â= â0.87) and cumulative area of 28 âmm2 (Specificity 92.2%, Sensitivity 81.3%, AUC â= â0.86).CONCLUSION:
HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds to predict HVD. CT following TAVR may determine patients at risk of HVD.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Estenose da Valva Aórtica
/
Próteses Valvulares Cardíacas
/
Substituição da Valva Aórtica Transcateter
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Cardiovasc Comput Tomogr
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
RADIOLOGIA
Ano de publicação:
2022
Tipo de documento:
Article