Jaffar M Khan1,2, Toby Rogers1,2, Ron Waksman1, Rebecca Torguson1, Gaby Weissman3, Diego Medvedofsky4, Paige E Craig1, Cheng Zhang1, Paul Gordon5, Afshin Ehsan6, Sean R Wilson7, John Goncalves8, Robert Levitt9, Chiwon Hahn10, Puja Parikh11, Thomas Bilfinger12, David Butzel13, Scott Buchanan13, Nicholas Hanna14, Robert Garrett15, Christian Shults16, Hector M Garcia-Garcia1, Paul Kolm1, Lowell F Satler1, Maurice Buchbinder17, Itsik Ben-Dor1, Federico M Asch4. 1. Section of Interventional Cardiology (J.M.K., T.R., R.W., R.T., P.E.C., C.Z., H.M.G.-G., P.K., L.F.S., I.B.-D.), Medstar Washington Hospital Center, DC. 2. Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., T.R.). 3. Department of Cardiology (G.W.), Medstar Washington Hospital Center, DC. 4. MedStar Health Research Institute (D.M., F.M.A.), Medstar Washington Hospital Center, DC. 5. Division of Cardiology, The Miriam Hospital, Providence, Rhode Island (P.G.). 6. Division of Cardiothoracic Surgery, Lifespan Cardiovascular Institute, Providence, Rhode Island (A.E.). 7. Department of Medicine (S.R.W.), The Valley Hospital, Ridgewood, NJ. 8. Cardiac Surgery Program (J.G.), The Valley Hospital, Ridgewood, NJ. 9. Department of Cardiology (R.L.), Henrico Doctors' Hospital, Richmond, Virginia. 10. Department of Cardiothoracic Surgery (C.W.), Henrico Doctors' Hospital, Richmond, Virginia. 11. Department of Medicine (P.P.), Stony Brook Hospital, NY. 12. Department of Surgery (T.B.), Stony Brook Hospital, NY. 13. Cardiovascular Service Line, Maine Medical Center, Portland (D.B., S.B.). 14. St John Heart Institute Cardiovascular Consultants, St John Health System, Tulsa, Oklahoma (N.H.). 15. St John Clinic Cardiovascular Surgery, St John Heart Institute Cardiovascular Consultants, St John Health System, Tulsa, Oklahoma (R.G.). 16. Department of Cardiac Surgery (C.S.), Medstar Washington Hospital Center, DC. 17. Foundation for Cardiovascular Medicine, Stanford University, California (M.B.).
Abstract
BACKGROUND: This analysis evaluated echocardiographic predictors of hypoattenuated leaflet thickening (HALT) in low-risk patients undergoing transcatheter aortic valve replacement and assessed 1-year clinical and hemodynamic consequences. HALT by computed tomography may be associated with early valve degeneration and increased neurological events. METHODS: Echocardiograms were performed at baseline, discharge, 30 days, and 1 year post-procedure. Four-dimensional contrast-enhanced computed tomography assessed HALT at 30 days. Independent core laboratories analyzed images. Doppler hemodynamic parameters were tested in a univariable regression model to identify HALT predictors. One-year clinical and hemodynamic outcomes were compared between HALT (+) and (-) patients. RESULTS: Analysis included 170 patients with Sapien 3 valves and diagnostic 30-day computed tomographies, of whom 27 (16%) had HALT. Baseline characteristics were similar between groups. After transcatheter aortic valve replacement, aortic flow was nonsignificantly reduced in patients who developed HALT. Regression analysis did not show significant association between baseline or discharge valve hemodynamics and development of HALT at 30 days. Patients with HALT had smaller aortic valve areas (1.4±0.4 versus 1.7±0.5 cm2; P=0.018) and Doppler velocity index (0.4±0.1 versus 0.5±0.1; P=0.003) than those without HALT at 30 days but not at 1 year. There was no difference in aortic mean gradient at 30 days. There was no difference between the groups in New York Heart Association class, 6-minute walk distance, and mortality at 1 year. CONCLUSIONS: There were no early hemodynamic predictors of HALT. At 30 days, patients with HALT had worse valve hemodynamics than those without HALT, but hemodynamic and clinical outcomes at 1 year were similar. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628899.
BACKGROUND: This analysis evaluated echocardiographic predictors of hypoattenuated leaflet thickening (HALT) in low-risk patients undergoing transcatheter aortic valve replacement and assessed 1-year clinical and hemodynamic consequences. HALT by computed tomography may be associated with early valve degeneration and increased neurological events. METHODS: Echocardiograms were performed at baseline, discharge, 30 days, and 1 year post-procedure. Four-dimensional contrast-enhanced computed tomography assessed HALT at 30 days. Independent core laboratories analyzed images. Doppler hemodynamic parameters were tested in a univariable regression model to identify HALT predictors. One-year clinical and hemodynamic outcomes were compared between HALT (+) and (-) patients. RESULTS: Analysis included 170 patients with Sapien 3 valves and diagnostic 30-day computed tomographies, of whom 27 (16%) had HALT. Baseline characteristics were similar between groups. After transcatheter aortic valve replacement, aortic flow was nonsignificantly reduced in patients who developed HALT. Regression analysis did not show significant association between baseline or discharge valve hemodynamics and development of HALT at 30 days. Patients with HALT had smaller aortic valve areas (1.4±0.4 versus 1.7±0.5 cm2; P=0.018) and Doppler velocity index (0.4±0.1 versus 0.5±0.1; P=0.003) than those without HALT at 30 days but not at 1 year. There was no difference in aortic mean gradient at 30 days. There was no difference between the groups in New York Heart Association class, 6-minute walk distance, and mortality at 1 year. CONCLUSIONS: There were no early hemodynamic predictors of HALT. At 30 days, patients with HALT had worse valve hemodynamics than those without HALT, but hemodynamic and clinical outcomes at 1 year were similar. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628899.
Authors: Jurrien H Kuneman; Gurpreet K Singh; Nicolaj C Hansson; Laura Fusini; Steen H Poulsen; Federico Fortuni; E Mara Vollema; Anders L D Pedersen; Andrea D Annoni; Bjarne L Nørgaard; Gianluca Pontone; Nina Ajmone Marsan; Victoria Delgado; Jeroen J Bax; Juhani Knuuti Journal: Int J Cardiovasc Imaging Date: 2021-10-16 Impact factor: 2.357