Valvular & structural heart disease
Investigation of factors determining haemodynamic relevance of leaflet thrombosis after transcatheter aortic valve implantation
Authors' 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.
Study context
- Population
- Patients after transcatheter aortic valve implantation (TAVI) (age 81.5 ± 5.5 years; female 63%)50 with hypoattenuated leaflet thickening (HALT)
- Participants
- 100 patients
- Exposure
- HALT vs no HALT after TAVI
- HALTn = 50
- Outcome
- Factors influencing echocardiographic mPG (haemodynamic relevance of HALT)
Methodological detailsblinded readers, electrocardiogram (ECG)-gated whole heart cycle CT angiography, After anonymization and randomization, blinded readers measured MT_pr and MR_pr on CT angiography
- Blinded readers
- ECG-gated whole heart cycle CT angiography
- After anonymization and randomization, blinded readers measured MT_pr and MR_pr on CT angiography
Main finding
As reported in the abstract
Influence on mPG (multiple regression)
- Valve size significant influence on mean pressure gradient (mPG)
- P = 0.001
- MT_pr significant influence on mPG
- P = 0.02
- Valve size moderated effect of MT_pr on mPG (interaction model)
- P = 0.004
Observational data: associations, not effects.
Further findings
Correlation of MT_pr with echocardiographic parameters, 23 mm valves (subgroup)
- mPG
- r = 0.57
- ΔmPG
- r = 0.68
- Doppler velocity index (DVI)
- r = 0.55
- Each P < 0.001
Correlation of MT_pr with echocardiographic parameters, 26 and 29 mm valves (subgroup)
- No strong correlation
- r < 0.2, P > 0.2
Haemodynamic valve deterioration (HVD) (mPG > 20 mmHg) by valve size
- Prostheses with HVD with 23 mm valve
- 6 of 7
- Prostheses with HVD with 29 mm valve
- 1
- P = 0.02
Original publication
Investigation of factors determining haemodynamic relevance of leaflet thrombosis after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging. Published 6 July 2023. doi:10.
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