Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement

Author:

Garcia Santiago1ORCID,Fukui Miho1ORCID,Dworak Marshall W.1ORCID,Okeson Brynn K.1ORCID,Garberich Ross1ORCID,Hashimoto Go1ORCID,Sato Hirotomo1,Cavalcante João L.1,Bapat Vinayak N.1,Lesser John1,Cheng Victor1,Newell Marc C.1,Goessl Mario1,Elmariah Sammy2ORCID,Bradley Steven M.1ORCID,Sorajja Paul1

Affiliation:

1. 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.).

2. Massachusetts General Hospital and Harvard Medical School, Boston (S.E.).

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3