PMID- 28369242
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20220316
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 38
IP  - 16
DP  - 2017 Apr 21
TI  - Transcatheter aortic valve thrombosis: the relation between hypo-attenuated 
      leaflet thickening, abnormal valve haemodynamics, and stroke.
PG  - 1207-1217
LID - 10.1093/eurheartj/ehx031 [doi]
AB  - AIMS: The presence of hypo-attenuated leaflet thickening (HALT) and/or reduced 
      leaflet motion on multi-detector row computed tomography (MDCT) has been proposed 
      as a possible marker for early transcatheter aortic valve thrombosis. However, 
      its association with abnormal valve haemodynamics on echocardiography (another 
      potential marker of thrombosis) and clinical outcomes (stroke) remains unclear. 
      The present study evaluated the prevalence of HALT on MDCT and abnormal valve 
      haemodynamics on echocardiography. In addition, the occurrence of ischemic stroke 
      and/or transient ischemic attack (TIA) was assessed. METHODS AND RESULTS: A total 
      of 434 patients (mean age 80 +/- 7 years, 51% male) who underwent transcatheter 
      aortic valve replacement (TAVR) were evaluated. Transcatheter valve haemodynamics 
      were assessed on echocardiography at discharge, 6 months, and thereafter yearly 
      (up to 3 years post-TAVR). The presence of HALT and/or reduced leaflet motion was 
      assessed on MDCT performed 35 days [interquartile range 19-210] after TAVR in 128 
      of these 434 patients. Possible TAVR valve thrombosis was defined by mean 
      transvalvular gradient >/=20 mmHg and aortic valve area (AVA) </=1.1cm2 on 
      echocardiography or by the presence of HALT or reduced leaflet motion on MDCT. 
      The occurrence of ischemic stroke/TIA at follow-up was recorded. HALT and/or 
      reduced leaflet motion was present in 12.5% of 128 patients undergoing MDCT, and 
      was associated with a slightly higher mean transvalvular gradient 
      (12.4 +/- 8.0 mmHg vs. 9.4 +/- 4.3 mmHg; P = 0.026) and smaller AVA (1.49 +/- 0.39 cm2 
      vs. 1.78 +/- 0.45 cm2, P = 0.017). Only one patient with HALT on MDCT revealed 
      abnormal valve haemodynamics on echocardiography. At 3-year follow-up, abnormal 
      valve haemodynamics on echocardiography were observed in 3% of patients. HALT on 
      MDCT and abnormal valve haemodynamics on echocardiography were not associated 
      with increased risk of ischemic stroke/TIA. CONCLUSION: On MDCT, 12.5% of 
      patients showed HALT or reduced leaflet motion, whereas only one of these 
      patients had abnormal valve haemodynamics on echocardiography. Neither HALT nor 
      increased transvalvular gradient were associated with stroke/TIA.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author 2017. For permissions, please email: journals.permissions@oup.com.
FAU - Vollema, E Mara
AU  - Vollema EM
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Kong, William K F
AU  - Kong WKF
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
AD  - Department of Cardiology, National University Heart Centre, Singapore.
FAU - Katsanos, Spyridon
AU  - Katsanos S
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
AD  - National and Kapodistrian University of Athens, School of Medicine, Attikon 
      University Hospital, Athens, Greece.
FAU - Kamperidis, Vasileios
AU  - Kamperidis V
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
AD  - Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
FAU - van Rosendael, Philippe J
AU  - van Rosendael PJ
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - van der Kley, Frank
AU  - van der Kley F
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - de Weger, Arend
AU  - de Weger A
AD  - Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, 
      The Netherlands.
FAU - Ajmone Marsan, Nina
AU  - Ajmone Marsan N
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Delgado, Victoria
AU  - Delgado V
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Bax, Jeroen J
AU  - Bax JJ
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2017 Apr 21;38(16):1218-1221. PMID: 28369457
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/surgery
MH  - Female
MH  - Heart Valve Diseases/etiology/*physiopathology
MH  - Heart Valve Prosthesis
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Ischemic Attack, Transient/etiology
MH  - Male
MH  - Multidetector Computed Tomography
MH  - Prospective Studies
MH  - Stroke/*etiology/physiopathology
MH  - Thrombosis/etiology/*physiopathology
MH  - *Transcatheter Aortic Valve Replacement
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Echocardiography
OT  - Multi-detector row computed tomography 
OT  - Stroke
OT  - Thrombosis
OT  - Transcatheter aortic valve replacement
EDAT- 2017/04/04 06:00
MHDA- 2018/04/03 06:00
CRDT- 2017/04/04 06:00
PHST- 2016/07/18 00:00 [received]
PHST- 2017/01/16 00:00 [accepted]
PHST- 2017/04/04 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
PHST- 2017/04/04 06:00 [entrez]
AID - 3091423 [pii]
AID - 10.1093/eurheartj/ehx031 [doi]
PST - ppublish
SO  - Eur Heart J. 2017 Apr 21;38(16):1207-1217. doi: 10.1093/eurheartj/ehx031.