PMID- 33660057 OWN - NLM STAT- MEDLINE DCOM- 20220208 LR - 20220208 IS - 1615-2573 (Electronic) IS - 0910-8327 (Linking) VI - 36 IP - 9 DP - 2021 Sep TI - Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up. PG - 1374-1383 LID - 10.1007/s00380-021-01803-4 [doi] AB - BACKGROUND: The clinical predictors and sequelae of leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is still unclear. Therefore, our aim was to determine the clinical predictors and sequelae at mid-term follow-up of computed tomography (CT)-defined LT following TAVR. METHODS AND RESULTS: We performed a prospective evaluation with a 320-multislice CT following TAVR for the presence of LT, defined as hypo-attenuated leaflet thickening (HALT). Four-dimensional CT image-rendering was performed to determine the presence of reduced leaflet motion (RELM). 172 patients [89 (51.7%) male, mean age 82.8 +/- 5.7 years] treated with commercially available TAVR device (Lotus 54%, CoreValve 32% and Sapien 3 14%) were included, with median CT-scan at 6.0 weeks post-TAVR. Prevalence of HALT was 14.0% (24 cases) and RELM was 9.8% (17 cases). On multivariate analysis, patients with HALT were less prescribed oral anticoagulation (OAC) (OR 9.9), received larger TAVR prostheses (OR 5.7) and higher rates of moderate-severe para-valvular regurgitation (PVR) (OR 16.3). There was no difference in clinical outcomes at a median follow-up of 2.3 years. Patients with RELM had significantly higher transvalvular gradients after discharge when compared to those without RELM. CONCLUSIONS: Absence of OAC, large TAVR prostheses and moderate-severe PVR were predictors for LT. Transvalvular gradients were higher in patients that developed RELM but not HALT. Further studies are warranted to determine the long-term impact of LT on TAVR durability. Prevalence of different sub-types of CT-defined LT (HALT and RELM) and the clinical predictors of developing LT following TAVR. CT computed tomography, HALT hypo-attenuated leaflet thickening, LT leaflet thrombosis, RELM reduced leaflet motion, TAVR transcatheter aortic valve replacement. CI - (c) 2021. Crown. FAU - Rashid, Hashrul N AU - Rashid HN AUID- ORCID: 0000-0002-1879-7172 AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Michail, Michael AU - Michail M AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. AD - Institute of Cardiovascular Science, University College London, London, UK. FAU - Ihdayhid, Abdul R AU - Ihdayhid AR AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. AD - St Paul's Hospital, Vancouver, BC, Canada. FAU - Dowling, Cameron AU - Dowling C AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Khav, Nancy AU - Khav N AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Tan, Sean AU - Tan S AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Ramnarain, Jaineel AU - Ramnarain J AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Cameron, James D AU - Cameron JD AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Nasis, Arthur AU - Nasis A AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Nicholls, Stephen J AU - Nicholls SJ AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. FAU - Gooley, Robert P AU - Gooley RP AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. robert.gooley@monashhealth.org. LA - eng GR - 1191131/National Health and Medical Research Council/ GR - 102452/National Heart Foundation of Australia/ GR - Kincaid-Smith Scholarship/Royal Australasian College of Physicians/ PT - Journal Article DEP - 20210304 PL - Japan TA - Heart Vessels JT - Heart and vessels JID - 8511258 SB - IM MH - Aged MH - Aged, 80 and over MH - Aortic Valve/diagnostic imaging/surgery MH - *Aortic Valve Stenosis/surgery MH - Female MH - Follow-Up Studies MH - *Heart Valve Prosthesis MH - Humans MH - Male MH - Multidetector Computed Tomography MH - *Thrombosis/diagnostic imaging/epidemiology/etiology MH - *Transcatheter Aortic Valve Replacement/adverse effects OTO - NOTNLM OT - Hypo-attenuated leaflet thickening OT - Leaflet thrombosis OT - Reduced leaflet motion OT - TAVI OT - TAVR EDAT- 2021/03/05 06:00 MHDA- 2022/02/09 06:00 CRDT- 2021/03/04 05:58 PHST- 2020/09/16 00:00 [received] PHST- 2021/02/05 00:00 [accepted] PHST- 2021/03/05 06:00 [pubmed] PHST- 2022/02/09 06:00 [medline] PHST- 2021/03/04 05:58 [entrez] AID - 10.1007/s00380-021-01803-4 [pii] AID - 10.1007/s00380-021-01803-4 [doi] PST - ppublish SO - Heart Vessels. 2021 Sep;36(9):1374-1383. doi: 10.1007/s00380-021-01803-4. Epub 2021 Mar 4.