PMID- 34852974
OWN - NLM
STAT- MEDLINE
DCOM- 20220301
LR  - 20220301
IS  - 1876-861X (Electronic)
IS  - 1876-861X (Linking)
VI  - 16
IP  - 2
DP  - 2022 Mar-Apr
TI  - The impact of hypo-attenuated leaflet thickening on haemodynamic valve 
      deterioration following transcatheter aortic valve replacement.
PG  - 168-173
LID - S1934-5925(21)00473-1 [pii]
LID - 10.1016/j.jcct.2021.11.013 [doi]
AB  - 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 ​mmHg with an increase in 
      gradient >/=10 ​mmHg 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 ​mm (IQR 1.9-4.7) and area of 64.2 ​mm(2) 
      (IQR 40.9-91.6). Thresholds for HALT in predicting HVD were a cumulative depth of 
      2.4 ​mm (Specificity 94.1%, Sensitivity 75.0%, AUC ​= ​0.87) and cumulative area 
      of 28 ​mm(2) (Specificity 92.2%, Sensitivity 81.3%, AUC ​= ​0.86). 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.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Rashid, Hashrul N
AU  - Rashid HN
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia. Electronic address: hashrul.rashid@monashhealth.org.
FAU - Michail, Michael
AU  - Michail M
AD  - Sussex Cardiac Centre, University Hospital Sussex NHS Trust, Brighton, United 
      Kingdom.
FAU - Ramnarain, Jaineel
AU  - Ramnarain J
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia.
FAU - Nasis, Arthur
AU  - Nasis A
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia.
FAU - Nicholls, Stephen J
AU  - Nicholls SJ
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia.
FAU - Cameron, James D
AU  - Cameron JD
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia.
FAU - Gooley, Robert P
AU  - Gooley RP
AD  - Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash 
      University, Australia.
LA  - eng
PT  - Journal Article
DEP - 20211126
PL  - United States
TA  - J Cardiovasc Comput Tomogr
JT  - Journal of cardiovascular computed tomography
JID - 101308347
SB  - IM
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery
MH  - *Heart Valve Prosthesis
MH  - Hemodynamics
MH  - Humans
MH  - Predictive Value of Tests
MH  - Risk Factors
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Haemodynamic valve deterioration
OT  - Leaflet thickening
OT  - Leaflet thrombosis
OT  - Reduced leaflet motion
OT  - TAVI
OT  - TAVR
COIS- Declaration of competing interest The authors declare the following financial 
      interests/personal relationships which may be considered as potential competing 
      interests: Dr Robert Gooley receives Honoraria from Boston Scientific, Medtronic 
      and Abbott Vascular. All the other authors report no conflict of interest.
EDAT- 2021/12/03 06:00
MHDA- 2022/03/03 06:00
CRDT- 2021/12/02 05:44
PHST- 2021/10/08 00:00 [received]
PHST- 2021/11/10 00:00 [revised]
PHST- 2021/11/24 00:00 [accepted]
PHST- 2021/12/03 06:00 [pubmed]
PHST- 2022/03/03 06:00 [medline]
PHST- 2021/12/02 05:44 [entrez]
AID - S1934-5925(21)00473-1 [pii]
AID - 10.1016/j.jcct.2021.11.013 [doi]
PST - ppublish
SO  - J Cardiovasc Comput Tomogr. 2022 Mar-Apr;16(2):168-173. doi: 
      10.1016/j.jcct.2021.11.013. Epub 2021 Nov 26.