Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

Lars Sondergaard; Ole De Backer; Klaus F Kofoed; Hasan Jilaihawi; Andreas Fuchs; Tarun Chakravarty; Mohammad Kashif; Yoshio Kazuno; Hiroyuki Kawamori; Yoshio Maeno; Gintautas Bieliauskas; Hongfei Guo; Gregg W Stone; Raj Makkar

doi:10.1093/eurheartj/ehx369

Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

Lars Sondergaard, Ole De Backer, Klaus F Kofoed, Hasan Jilaihawi, Andreas Fuchs, Tarun Chakravarty, Mohammad Kashif, Yoshio Kazuno, Hiroyuki Kawamori, Yoshio Maeno, Gintautas Bieliauskas, Hongfei Guo, Gregg W Stone, Raj Makkar

Institut for Klinisk Medicin

94 Citationer (Scopus)

Abstract

Aims Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-Attenuating leaflet thickening (HALT) with or without hypo-Attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. Methods and results The SAVORY registry enrolled patients treated by TAVI (n= 75) or SAVR (n= 30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-Thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140± 152 days and 298± 141 days after valve implantation, respectively. Hypo-Attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P= 0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. Conclusions Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	38
Udgave nummer	28
Sider (fra-til)	2201-2207
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehx369
Status	Udgivet - 21 jul. 2017

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10.1093/eurheartj/ehx369

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Sondergaard, L., De Backer, O., Kofoed, K. F., Jilaihawi, H., Fuchs, A., Chakravarty, T., Kashif, M., Kazuno, Y., Kawamori, H., Maeno, Y., Bieliauskas, G., Guo, H., Stone, G. W., & Makkar, R. (2017). Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves. European Heart Journal, 38(28), 2201-2207. https://doi.org/10.1093/eurheartj/ehx369

Sondergaard, L, De Backer, O, Kofoed, KF, Jilaihawi, H, Fuchs, A, Chakravarty, T, Kashif, M, Kazuno, Y, Kawamori, H, Maeno, Y, Bieliauskas, G, Guo, H, Stone, GW & Makkar, R 2017, 'Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves', European Heart Journal, bind 38, nr. 28, s. 2201-2207. https://doi.org/10.1093/eurheartj/ehx369

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title = "Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves",

abstract = "Aims Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-Attenuating leaflet thickening (HALT) with or without hypo-Attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. Methods and results The SAVORY registry enrolled patients treated by TAVI (n= 75) or SAVR (n= 30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-Thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140± 152 days and 298± 141 days after valve implantation, respectively. Hypo-Attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P= 0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. Conclusions Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy.",

author = "Lars Sondergaard and {De Backer}, Ole and Kofoed, {Klaus F} and Hasan Jilaihawi and Andreas Fuchs and Tarun Chakravarty and Mohammad Kashif and Yoshio Kazuno and Hiroyuki Kawamori and Yoshio Maeno and Gintautas Bieliauskas and Hongfei Guo and Stone, {Gregg W} and Raj Makkar",

year = "2017",

month = jul,

day = "21",

doi = "10.1093/eurheartj/ehx369",

language = "English",

volume = "38",

pages = "2201--2207",

journal = "European Heart Journal",

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TY - JOUR

T1 - Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

AU - Sondergaard, Lars

AU - De Backer, Ole

AU - Kofoed, Klaus F

AU - Jilaihawi, Hasan

AU - Fuchs, Andreas

AU - Chakravarty, Tarun

AU - Kashif, Mohammad

AU - Kazuno, Yoshio

AU - Kawamori, Hiroyuki

AU - Maeno, Yoshio

AU - Bieliauskas, Gintautas

AU - Guo, Hongfei

AU - Stone, Gregg W

AU - Makkar, Raj

PY - 2017/7/21

Y1 - 2017/7/21

N2 - Aims Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-Attenuating leaflet thickening (HALT) with or without hypo-Attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. Methods and results The SAVORY registry enrolled patients treated by TAVI (n= 75) or SAVR (n= 30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-Thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140± 152 days and 298± 141 days after valve implantation, respectively. Hypo-Attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P= 0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. Conclusions Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy.

AB - Aims Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-Attenuating leaflet thickening (HALT) with or without hypo-Attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. Methods and results The SAVORY registry enrolled patients treated by TAVI (n= 75) or SAVR (n= 30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-Thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140± 152 days and 298± 141 days after valve implantation, respectively. Hypo-Attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P= 0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. Conclusions Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy.

U2 - 10.1093/eurheartj/ehx369

DO - 10.1093/eurheartj/ehx369

M3 - Journal article

C2 - 28838044

SN - 0195-668X

VL - 38

SP - 2201

EP - 2207

JO - European Heart Journal

JF - European Heart Journal

IS - 28

ER -

Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

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