PMID- 32756984
OWN - NLM
STAT- MEDLINE
DCOM- 20210625
LR  - 20210625
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 21
IP  - 12
DP  - 2020 Dec 1
TI  - Quantification of hypo-attenuated leaflet thickening after transcatheter aortic 
      valve implantation: clinical relevance of hypo-attenuated leaflet thickening 
      volume.
PG  - 1395-1404
LID - 10.1093/ehjci/jeaa184 [doi]
AB  - AIMS: Our aim was to establish an objective, quantitative methodology for 
      volumetric hypo-attenuated leaflet thickening (HALT) diagnosis and evaluate its 
      clinical significance. METHODS AND RESULTS: We prospectively enrolled 144 
      patients who underwent transcatheter aortic valve implantation (TAVI) between 
      2011 and 2016. At inclusion, cardiac computed tomography angiography (CTA), 
      transthoracic echocardiography, and brain magnetic resonance imaging (MRI) were 
      performed. We quantified HALT on CTA datasets by segmenting the inner volume of 
      TAVI frame at the level of leaflets and extracted voxels between a threshold of 
      -200 to 200 HU based on prior recommendation. The median HALT volume was 72 
      [inter-quartile range (IQR): 1-154] mm3 (intra- and inter-reader agreement: 
      intra-class correlation coefficient = 0.92 and 0.94, respectively) and 79% 
      (n = 87/111) of the patients had HALT >0 mm3. In multivariate linear regression, 
      oral anti-coagulation (beta: -0.32; 95% CI: -0.62 to -0.01; P = 0.004) and history 
      of myocardial infarction (beta: 0.32; 95% CI: 0.01-0.63; P = 0.043) were associated 
      with HALT quantity. Log-transformed HALT volume was associated with elevated 
      (>13 mmHg) aortic mean gradient (AMG, OR: 12.85; 95% CI: 1.96-152.93; P = 0.021) 
      and moderate-to-severe valvular degeneration (AMG >/= 20 mmHg or DeltaAMG >/= 10 mmHg; 
      OR: 10.56; 95% CI: 1.44-148.71; P = 0.046) but did not predict ischaemic brain 
      lesions on MRI or all-cause death after a median follow-up of 29 (IQR: 11-29) 
      months (all P > 0.05). CONCLUSION: Through systematic analysis of asymptomatic 
      patients with TAVI, an objective and reproducible methodology was feasible for 
      volumetric measurement of HALT. Anti-coagulation might have a protective effect 
      against HALT. Ischaemic brain lesions and all-cause death were not associated 
      with HALT; nevertheless, it might deteriorate prosthesis function due to its 
      association with elevated AMG. CLINICAL TRIAL REGISTRATION: 
      http//:www.ClinicalTrials.gov; NCT02826200.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
FAU - Karady, Julia
AU  - Karady J
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
AD  - Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts 
      General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 
      02114, USA.
FAU - Apor, Astrid
AU  - Apor A
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Nagy, Aniko I
AU  - Nagy AI
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
AD  - Department of Medicine, Karolinska Institutet, 1 Solnavagen, Solna 171 77, 
      Stockholm, Sweden.
FAU - Kolossvary, Marton
AU  - Kolossvary M
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Bartykowszki, Andrea
AU  - Bartykowszki A
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Szilveszter, Balint
AU  - Szilveszter B
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Simon, Judit
AU  - Simon J
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Molnar, Levente
AU  - Molnar L
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Jermendy, Adam L
AU  - Jermendy AL
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Panajotu, Alexisz
AU  - Panajotu A
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Suhai, Ferenc I
AU  - Suhai FI
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Varga, Andrea
AU  - Varga A
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
FAU - Rajani, Ronak
AU  - Rajani R
AD  - Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster 
      Bridge Road, London SE1 7EH, UK.
FAU - Maurovich-Horvat, Pal
AU  - Maurovich-Horvat P
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
AD  - Department of Radiology, Medical Imaging Centre, Semmelweis University, 78 Ulloi 
      St, Budapest 1082, Hungary.
FAU - Merkely, Bela
AU  - Merkely B
AD  - MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, 
      Semmelweis University, 68 Varosmajor St, Budapest 1122, Hungary.
LA  - eng
SI  - ClinicalTrials.gov/NCT02826200
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
EIN - Eur Heart J Cardiovasc Imaging. 2020 Dec 1;21(12):1404. PMID: 32949139
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - *Thrombosis
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - aortic valve stenosis
OT  - cardiac CT angiography
OT  - hypo-attenuated leaflet thickening
OT  - transcatheter aortic valve implantation
EDAT- 2020/08/07 06:00
MHDA- 2021/06/29 06:00
CRDT- 2020/08/07 06:00
PHST- 2020/04/06 00:00 [received]
PHST- 2020/05/13 00:00 [revised]
PHST- 2020/06/03 00:00 [accepted]
PHST- 2020/08/07 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/08/07 06:00 [entrez]
AID - 5881467 [pii]
AID - 10.1093/ehjci/jeaa184 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2020 Dec 1;21(12):1395-1404. doi: 
      10.1093/ehjci/jeaa184.