PMID- 37022472
OWN - NLM
STAT- MEDLINE
DCOM- 20240125
LR  - 20240204
IS  - 1861-0692 (Electronic)
IS  - 1861-0684 (Print)
IS  - 1861-0684 (Linking)
VI  - 113
IP  - 1
DP  - 2024 Jan
TI  - Commissural misalignment independently predicts leaflet thrombosis after 
      transcatheter aortic valve implantation.
PG  - 29-37
LID - 10.1007/s00392-023-02192-6 [doi]
AB  - AIMS: Transcatheter aortic valve implantation (TAVI) has become a minimally 
      invasive alternative to surgical aortic valve replacement. Hypo-attenuated 
      leaflet thickening (HALT)-a marker of subclinical leaflet thrombosis commonly 
      detected by cardiac computed tomography (CT) after TAVI-may influence valve 
      durability and function. The purpose of this study was to compare commissural 
      alignment of the native and prosthetic aortic valves in cardiac CT in subjects 
      with and without HALT and thereby identify commissural misalignment as potential 
      predictor for leaflet thrombosis after TAVI. METHODS AND RESULTS: In 170 
      subjects, 85 with and 85 without HALT in post-TAVI CT, commissural orientation of 
      the prosthesis was determined comparing native and prosthetic aortic valve 
      orientation in cardiac CT by measuring the commissural angle relative to the 
      right coronary ostium in the aortic valve plane. For the prosthetic valve, any 
      deviation </= 15 degrees  compared to the native valve was classified as "aligned"; 16-30 degrees  
      as "mild", 31-45 degrees  as "moderate" and >/= 45 degrees  as "severe" misalignment. Among 
      subjects with HALT, median angular deviation was higher (36 degrees , IQR 31 degrees ) than in 
      the control group (29 degrees , IQR 29 degrees , p = 0.042). "Severe" misalignment was more 
      frequent in subjects who developed HALT (n = 31, 37%) compared to the control 
      group (n = 17, 20%, p = 0.013). In logistic regression analysis, more severe 
      deviation (p = 0.015, OR = 1.02 per 1 degrees  deviation) and "severe" misalignment 
      (p = 0.018, OR = 2.2) represented independent predictors for the occurrence of 
      HALT after TAVI. CONCLUSION: Subclinical leaflet thrombosis after TAVI is 
      associated with commissural misalignment. Potential clinical advantages of 
      obtaining commissural alignment remain to be systematically assessed.
CI  - (c) 2023. The Author(s).
FAU - Jung, Susanne
AU  - Jung S
AUID- ORCID: 0000-0002-4031-6304
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany. susanne.jung@uk-erlangen.de.
FAU - Ammon, Fabian
AU  - Ammon F
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany.
FAU - Smolka, Silvia
AU  - Smolka S
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany.
FAU - Moshage, Maximilian
AU  - Moshage M
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany.
FAU - Marwan, Mohamed
AU  - Marwan M
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany.
FAU - Achenbach, Stephan
AU  - Achenbach S
AD  - Medizinische Klinik 2, Kardiologie und Angiologie, Universitatsklinikum Erlangen, 
      Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Ulmenweg 18, 91054, 
      Erlangen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20230406
PL  - Germany
TA  - Clin Res Cardiol
JT  - Clinical research in cardiology : official journal of the German Cardiac Society
JID - 101264123
SB  - IM
MH  - Humans
MH  - *Transcatheter Aortic Valve Replacement/methods
MH  - Aortic Valve/surgery
MH  - *Aortic Valve Stenosis/surgery
MH  - *Heart Valve Prosthesis
MH  - *Thrombosis/epidemiology
MH  - Treatment Outcome
PMC - PMC10808532
OTO - NOTNLM
OT  - Commissural misalignment
OT  - HALT
OT  - Leaflet thrombosis
OT  - TAVI
COIS- Mohamed Marwan received speaker honoraria from Siemens Healthineers, Edwards 
      Lifescience and Amgen. There is a consulting agreement with Edwards 
      Lifescience. All the other authors report that they have no conflicts of interest 
      to declare.
EDAT- 2023/04/07 06:00
MHDA- 2024/01/25 06:43
PMCR- 2023/04/06
CRDT- 2023/04/06 11:18
PHST- 2022/08/19 00:00 [received]
PHST- 2023/03/24 00:00 [accepted]
PHST- 2024/01/25 06:43 [medline]
PHST- 2023/04/07 06:00 [pubmed]
PHST- 2023/04/06 11:18 [entrez]
PHST- 2023/04/06 00:00 [pmc-release]
AID - 10.1007/s00392-023-02192-6 [pii]
AID - 2192 [pii]
AID - 10.1007/s00392-023-02192-6 [doi]
PST - ppublish
SO  - Clin Res Cardiol. 2024 Jan;113(1):29-37. doi: 10.1007/s00392-023-02192-6. Epub 
      2023 Apr 6.