PMID- 35236097
OWN - NLM
STAT- MEDLINE
DCOM- 20220418
LR  - 20220418
IS  - 1941-7632 (Electronic)
IS  - 1941-7640 (Linking)
VI  - 15
IP  - 3
DP  - 2022 Mar
TI  - Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic 
      Valve Replacement.
PG  - e011480
LID - 10.1161/CIRCINTERVENTIONS.121.011480 [doi]
AB  - BACKGROUND: Hypoattenuated leaflet thickening (HALT), identified on functional 
      cardiac computed tomography (CTA), can affect valve function and clinical 
      outcomes. The objective of this study was to assess the impact of HALT on 
      clinical outcomes in patients treated with transcatheter aortic valve replacement 
      (TAVR). METHODS: In July 2015, Minneapolis Heart Institute implemented 
      prospective screening of HALT at 30-day post-TAVR with CTA. Patients with 
      evidence of HALT were recommended to initiate anticoagulation for 3 to 6 months 
      with warfarin. Echocardiographic, ischemic, and bleeding outcomes were compared 
      between HALT+ and HALT- patients. Survival rates were compared between HALT+ and 
      HALT- patients using log-rank test, with Cox regression analysis used to identify 
      variables independently associated with long-term death landmarked at time of 
      CTA. This analysis included patients treated from July 1, 2015 to October 31, 
      2019. RESULTS: Of 856 patients undergoing TAVR during the study period, 638 (75%) 
      underwent CTA post-TAVR (median time 31 [30-37] days). HALT+ was evident in 79 
      (12.3%). HALT+ patients were more likely prescribed warfarin at 1, 3, and 12 
      months (all P<0.001) and had similar gradients compared with HALT- patients. 
      After a median follow-up of 2.2 years (1.5-3.2), HALT+ patients had increased 
      mortality (30% versus 20%; P=0.001). In Cox regression analysis, presence of HALT 
      (hazard ratio, 1.83 [95% CI, 1.13-2.97]; P=0.014) remained independently 
      associated with long-term mortality. CONCLUSIONS: In a large, real-world cohort 
      of patients receiving TAVR followed by systematic screening with CTA 30-days 
      post-procedure, HALT was found in 12% of patients and independently associated 
      with long-term mortality. Findings of this nonrandomized, observational cohort 
      study require independent validation.
FAU - Garcia, Santiago
AU  - Garcia S
AUID- ORCID: 0000-0002-1806-6783
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Fukui, Miho
AU  - Fukui M
AUID- ORCID: 0000-0002-7235-5551
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Dworak, Marshall W
AU  - Dworak MW
AUID- ORCID: 0000-0001-6847-2416
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Okeson, Brynn K
AU  - Okeson BK
AUID- ORCID: 0000-0002-6912-7259
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Garberich, Ross
AU  - Garberich R
AUID- ORCID: 0000-0001-9470-4700
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Hashimoto, Go
AU  - Hashimoto G
AUID- ORCID: 0000-0001-5067-2786
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Sato, Hirotomo
AU  - Sato H
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Cavalcante, Joao L
AU  - Cavalcante JL
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Bapat, Vinayak N
AU  - Bapat VN
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Lesser, John
AU  - Lesser J
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Cheng, Victor
AU  - Cheng V
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Newell, Marc C
AU  - Newell MC
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Goessl, Mario
AU  - Goessl M
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Elmariah, Sammy
AU  - Elmariah S
AUID- ORCID: 0000-0002-8013-8733
AD  - Massachusetts General Hospital and Harvard Medical School, Boston (S.E.).
FAU - Bradley, Steven M
AU  - Bradley SM
AUID- ORCID: 0000-0003-4006-6760
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
FAU - Sorajja, Paul
AU  - Sorajja P
AD  - Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., 
      M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., 
      S.M.B., P.S.).
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20220303
PL  - United States
TA  - Circ Cardiovasc Interv
JT  - Circulation. Cardiovascular interventions
JID - 101499602
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
CIN - Circ Cardiovasc Interv. 2022 Mar;15(3):e011828. PMID: 35236098
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/etiology/surgery
MH  - *Heart Valve Prosthesis/adverse effects
MH  - Humans
MH  - Prospective Studies
MH  - Risk Factors
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
MH  - Warfarin/adverse effects
OTO - NOTNLM
OT  - survival rate
OT  - tomography
OT  - warfarin
EDAT- 2022/03/04 06:00
MHDA- 2022/04/19 06:00
CRDT- 2022/03/03 05:29
PHST- 2022/03/04 06:00 [pubmed]
PHST- 2022/04/19 06:00 [medline]
PHST- 2022/03/03 05:29 [entrez]
AID - 10.1161/CIRCINTERVENTIONS.121.011480 [doi]
PST - ppublish
SO  - Circ Cardiovasc Interv. 2022 Mar;15(3):e011480. doi: 
      10.1161/CIRCINTERVENTIONS.121.011480. Epub 2022 Mar 3.