Author + information
- Received April 28, 2016
- Revision received October 22, 2016
- Accepted November 10, 2016
- Published online January 2, 2017.
- Ryo Yanagisawa, MDa,
- Kentaro Hayashida, MD, PhDa,∗ (, )
- Yoshitake Yamada, MD, PhDb,
- Makoto Tanaka, MDa,
- Fumiaki Yashima, MDa,
- Taku Inohara, MD, PhDa,
- Takahide Arai, MDa,
- Takashi Kawakami, MD, PhDa,
- Yuichiro Maekawa, MD, PhDa,
- Hikaru Tsuruta, MDa,
- Yuji Itabashi, MD, PhDa,
- Mitsushige Murata, MD, PhDa,
- Motoaki Sano, MD, PhDa,
- Kazuma Okamoto, MD, PhDc,
- Akihiro Yoshitake, MD, PhDc,
- Hideyuki Shimizu, MD, PhDc,
- Masahiro Jinzaki, MD, PhDb and
- Keiichi Fukuda, MD, PhDa
- aDepartment of Cardiology, Keio University School of Medicine, Tokyo, Japan
- bDepartment of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
- cDepartment of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Kentaro Hayashida, Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement.
Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis.
Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed.
Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups.
Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.
Drs. Hayashida and Shimizu are proctors for Edwards Lifesciences. Dr. Jinzaki has received grants from Toshiba Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Yanagisawa and Hayashida contributed equally to this study.
- Received April 28, 2016.
- Revision received October 22, 2016.
- Accepted November 10, 2016.
- American College of Cardiology Foundation