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

Martin Soschynski; Manuel Hein; Fabio Capilli; Muhammad Taha Hagar; Philipp Ruile; Philipp Breitbart; Dirk Westermann; Jana Taron; Christopher Schuppert; Christopher L Schlett; Fabian Bamberg; Tobias Krauss

doi:10.1093/ehjci/jead156

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

Eur Heart J Cardiovasc Imaging. 2023 Nov 23;24(12):1672-1681. doi: 10.1093/ehjci/jead156.

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
² Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
³ Department of Radiology, Neuroradiology and Nuclear Medicine, Medical Center Vest, Ruhr University Bochum, Dorstener Straße 151, 45657 Recklinghausen, Germany.
⁴ Cardiac MR PET CT Program, Massachusetts General-Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.

PMID: 37409579
DOI: 10.1093/ehjci/jead156

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.

Publication types

Comment

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / complications
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Female
Heart Valve Prosthesis* / adverse effects
Humans
Male
Stroke Volume
Thrombosis* / diagnostic imaging
Thrombosis* / etiology
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome
Ventricular Function, Left