PMID- 35192871
OWN - NLM
STAT- MEDLINE
DCOM- 20230527
LR  - 20230527
IS  - 1535-6280 (Electronic)
IS  - 0146-2806 (Linking)
VI  - 48
IP  - 7
DP  - 2023 Jul
TI  - Gender Differences and Outcomes of Hypoattenuated Leaflet Thickening (HALT) 
      Following Transcatheter Aortic Valve Replacement: A Meta-analysis of Randomized 
      and Cohort Studies.
PG  - 101155
LID - S0146-2806(22)00052-4 [pii]
LID - 10.1016/j.cpcardiol.2022.101155 [doi]
AB  - Subclinical leaflet thrombosis is characterized by hypoattenuated leaflet 
      thickening (HALT) after transcatheter aortic valve replacement (TAVR) on computed 
      tomography. However, given the low incidence of HALT after TAVR, the clinical 
      significance of HALT is still being investigated. We sought to generate a more 
      reliable estimate of the risk factors and adverse outcomes associated with HALT 
      after TAVR by pooling data from randomized trials and cohort studies. 
      PubMed/Medline database was systematically searched from inception until November 
      24, 2021, using the following terms: ("hypoattenuated leaflet thickening" and 
      "transcatheter aortic valve replacement") and ("Subclinical leaflet thrombosis" 
      and "transcatheter aortic valve replacement"). A random effects model 
      meta-analysis was conducted using Mantel-Haenszel odds ratios (ORs) and the 
      associated 95% confidence intervals (CIs), mean difference and the associated 
      95%. Ten studies with a total of 1462 patients were included, with follow-up 
      ranging between 4 months and 3 years. HALT occurred in 14.4% of the patients 
      undergoing TAVR. HALT was not associated with increased risk of stroke/TIA (OR 
      1.38; 95% CI [0.61-3.11]; I2=0%) or increased risk of all-cause mortality (OR 
      0.67; 95% CI [0.25-1.80]; I2=0). HALT was associated with a greater 
      post-procedural mean aortic valve gradient (mean difference 2.31 mmHg; 95% CI 
      [0.27, 4.35]; I2=71%). Interestingly, there was a trend of higher risk of HALT in 
      men (OR 1.37; 95% CI [0.82-2.30]; I2=44%) while there was a trend towards lower 
      risk of HALT in the presence of CKD (OR 0.76; 95% CI [0.49-1.19]; I2=0%); these 
      trends did not reach statistical significance. This meta-analysis shows that the 
      occurrence of HALT following TAVR is associated with a greater post-procedural 
      mean aortic valve gradient but no excess risk of death or cerebrovascular events. 
      The clinical significance of this higher post-procedural mean aortic valve 
      gradient is uncertain and requires further investigations.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Salah, Husam M
AU  - Salah HM
AD  - Department of Medicine, Division of Cardiology. University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Almaddah, Nureddin
AU  - Almaddah N
AD  - Arkansas Heart Hospital, Little Rock, AR.
FAU - Xu, Jack
AU  - Xu J
AD  - Department of Medicine, Division of Cardiology. University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Al-Hawwas, Malek
AU  - Al-Hawwas M
AD  - Department of Medicine, Division of Cardiology. University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Agarwal, Shiv Kumar
AU  - Agarwal SK
AD  - Central Arkansas Veterans Health System, Little Rock, AR.
FAU - Uretsky, Barry F
AU  - Uretsky BF
AD  - Central Arkansas Veterans Health System, Little Rock, AR.
FAU - Dhar, Gaurav
AU  - Dhar G
AD  - Department of Medicine, Division of Cardiology. University of Arkansas for 
      Medical Sciences, Little Rock, AR.
FAU - Al'Aref, Subhi J
AU  - Al'Aref SJ
AD  - Department of Medicine, Division of Cardiology. University of Arkansas for 
      Medical Sciences, Little Rock, AR.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20220219
PL  - Netherlands
TA  - Curr Probl Cardiol
JT  - Current problems in cardiology
JID - 7701802
SB  - IM
MH  - Humans
MH  - Male
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/surgery
MH  - Clinical Relevance
MH  - Cohort Studies
MH  - *Heart Valve Prosthesis
MH  - Risk Factors
MH  - Sex Factors
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
EDAT- 2022/02/23 06:00
MHDA- 2023/05/26 06:42
CRDT- 2022/02/22 20:09
PHST- 2022/02/06 00:00 [received]
PHST- 2022/02/16 00:00 [accepted]
PHST- 2023/05/26 06:42 [medline]
PHST- 2022/02/23 06:00 [pubmed]
PHST- 2022/02/22 20:09 [entrez]
AID - S0146-2806(22)00052-4 [pii]
AID - 10.1016/j.cpcardiol.2022.101155 [doi]
PST - ppublish
SO  - Curr Probl Cardiol. 2023 Jul;48(7):101155. doi: 10.1016/j.cpcardiol.2022.101155. 
      Epub 2022 Feb 19.