PMID- 28838044 OWN - NLM STAT- MEDLINE DCOM- 20180529 LR - 20220317 IS - 1522-9645 (Electronic) IS - 0195-668X (Linking) VI - 38 IP - 28 DP - 2017 Jul 21 TI - Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves. PG - 2201-2207 LID - 10.1093/eurheartj/ehx369 [doi] AB - AIMS: Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-attenuating leaflet thickening (HALT) with or without hypo-attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. METHODS AND RESULTS: The SAVORY registry enrolled patients treated by TAVI (n = 75) or SAVR (n = 30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140 +/- 152 days and 298 +/- 141 days after valve implantation, respectively. Hypo-attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P = 0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. CONCLUSIONS: Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy. REGISTERED AT CLINICALTRIALS.GOV: NCT02426307. 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 - Sondergaard, Lars AU - Sondergaard L AD - Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. FAU - De Backer, Ole AU - De Backer O AD - Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. FAU - Kofoed, Klaus F AU - Kofoed KF AD - Department of Cardiology and Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. FAU - Jilaihawi, Hasan AU - Jilaihawi H AD - Department of Cardiology, NYU Langone Medical Center, 530?1st Avenue, Skirball 9N, New York, NY 10016, USA. FAU - Fuchs, Andreas AU - Fuchs A AD - Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. FAU - Chakravarty, Tarun AU - Chakravarty T AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. FAU - Kashif, Mohammad AU - Kashif M AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. FAU - Kazuno, Yoshio AU - Kazuno Y AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. FAU - Kawamori, Hiroyuki AU - Kawamori H AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. FAU - Maeno, Yoshio AU - Maeno Y AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. FAU - Bieliauskas, Gintautas AU - Bieliauskas G AD - Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. FAU - Guo, Hongfei AU - Guo H AD - St. Jude Medical, 5050 Nathan Ln N, Plymouth, MN 55442, USA. FAU - Stone, Gregg W AU - Stone GW AD - New York Presbyterian, Columbia University Medical Center, The Cardiovascular Research Foundation, 111 East 59th Street, 11th Floor, New York, NY 10022, USA. FAU - Makkar, Raj AU - Makkar R AD - Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. LA - eng SI - ClinicalTrials.gov/NCT02426307 PT - Clinical Trial PT - Journal Article PL - England TA - Eur Heart J JT - European heart journal JID - 8006263 SB - IM CIN - Eur Heart J. 2017 Jul 21;38(28):2208-2210. PMID: 28838043 MH - Aged MH - Aortic Valve/*physiopathology MH - Aortic Valve Insufficiency/etiology MH - Aortic Valve Stenosis/physiopathology/*surgery MH - *Bioprosthesis MH - Echocardiography MH - Female MH - Graft Occlusion, Vascular/etiology/physiopathology MH - *Heart Valve Prosthesis MH - Humans MH - Male MH - Middle Aged MH - Movement/physiology MH - Postoperative Complications/etiology MH - Prosthesis Failure MH - Registries MH - Thrombosis/*etiology MH - Transcatheter Aortic Valve Replacement EDAT- 2017/08/26 06:00 MHDA- 2018/05/31 06:00 CRDT- 2017/08/26 06:00 PHST- 2017/01/15 00:00 [received] PHST- 2017/06/11 00:00 [accepted] PHST- 2017/08/26 06:00 [entrez] PHST- 2017/08/26 06:00 [pubmed] PHST- 2018/05/31 06:00 [medline] AID - 3924514 [pii] AID - 10.1093/eurheartj/ehx369 [doi] PST - ppublish SO - Eur Heart J. 2017 Jul 21;38(28):2201-2207. doi: 10.1093/eurheartj/ehx369.