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Comment
. 2023 Nov 23;24(12):1672-1681.
doi: 10.1093/ehjci/jead156.

Investigation of factors determining haemodynamic relevance of leaflet thrombosis after transcatheter aortic valve implantation

Martin Soschynski  1 , Manuel Hein  2 , Fabio Capilli  3 , Muhammad Taha Hagar  1 , Philipp Ruile  2 , Philipp Breitbart  2 , Dirk Westermann  2 , Jana Taron  1   4 , Christopher Schuppert  1 , Christopher L Schlett  1 , Fabian Bamberg  1 , Tobias Krauss  1
Affiliations
Comment

Investigation of factors determining haemodynamic relevance of leaflet thrombosis after transcatheter aortic valve implantation

Martin Soschynski et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: To determine the conditions under which early hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) becomes haemodynamically relevant.

Methods and results: The study included 100 patients (age: 81.5 ± 5.5 years; female 63%), thereof 50 patients with HALT. After anonymization and randomization, blinded readers measured maximum thrombus thickness per prosthesis (MT_pr) and movement restriction (MR_pr) on electrocardiogram (ECG)-gated whole heart cycle computed tomography angiography. These measurements were compared with echocardiographic mean pressure gradient (mPG), its increase from baseline (ΔmPG), and Doppler velocity index (DVI). Haemodynamic valve deterioration (HVD) was defined as mPG > 20 mmHg. Age, body mass index, valve type, valve size, left ventricular ejection fraction, and atrial fibrillation were considered as influencing factors. Multiple regression analysis revealed that only valve size (P = 0.001) and MT_pr (P = 0.02) had a significant influence on mPG. In an interaction model, valve size moderated the effect of MT_pr on mPG significantly (P = 0.004). Sub-group analysis stratified by valve sizes showed a strong correlation between MT_pr and echocardiographic parameters for 23 mm valves (mPG: r = 0.57, ΔmPG: r = 0.68, DVI: r = 0.55, each with P < 0.001), but neither for 26 nor 29 mm valves (r < 0.2, P > 0.2 for all correlations). Six of seven prostheses with HVD had a 23 mm valve diameter, while one had 29 mm (P = 0.02).

Conclusion: Early HALT rarely causes significant mPG increase. Our study shows that valve size is a key factor influencing the haemodynamic impact of HALT. In small valve sizes, mPG is more likely to increase. Our study is the first to offer in vivo evidence supporting previous in vitro findings on this topic.

Keywords: haemodynamic relevance; hypoattenuated leaflet thickening; maximum thrombus thickness; transcatheter aortic valve implantation; valve size.

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Conflict of interest statement

Conflict of interest: F.B.: Bayer Healthcare, speakers bureau and unrestricted research grant Siemens Healthineers, speakers bureau and unrestricted research grant, unrelated to this work. C.L.S.: Siemens Healthineers, unrestricted research grant, unrelated to this work. J.T.: funding by Deutsche Forschungsgesellschaft (DFG, German Research Foundation)—TA 1438/1–2. T; speakers bureau Siemens Healthcare GmbH and speakers bureau Bayer AG, reviewer Universimed Cross Media Content GmbH and consultant Core Lab Black Forrest GmbH, all unrelated to this work. M.S.: electronic presentation sponsored by Bayer AG, unrelated to this work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment on

  • Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves.
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