Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Cardiology and Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Eur Heart J. 2017 Jul 21;38(28):2201-2207. doi: 10.1093/eurheartj/ehx369.
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.
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.
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.
REGISTERED AT CLINICALTRIALS.GOV: NCT02426307.
经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）后，四维容积 CT（4DCT）显示存在瓣叶变薄伴低衰减（HALT）和瓣叶运动受影响伴低衰减（HAM）。这些现象的演变时间模式尚不确定。
SAVORY 注册研究纳入了 TAVI（n=75）或 SAVR（n=30）治疗的患者，两次 4DCT 扫描均充分解释 HALT 和 HAM，两次扫描之间抗栓药物不变。进行逻辑回归分析，以检查 HALT 和 HAM 的演变，同时考虑人口统计学和基线变量、两次 CT 扫描的时间、瓣膜类型和抗栓治疗。分析人群包括 84 例患者，他们的第一次和第二次 CT 扫描分别在瓣膜植入后 140±152 天和 298±141 天进行。32 例（38.1%）患者存在瓣叶变薄伴低衰减，17 例（20.2%）患者存在 HAM。两种发现均为动态变化，13 例（15.5%）患者进展，9 例（10.7%）患者消退。与抗血小板治疗相比，接受维生素 K 拮抗剂或非维生素 K 拮抗剂的口服抗凝剂治疗的患者进展可能性较小（比值比：0.014，P=0.036）。慢性口服抗凝治疗维持并非回归的显著预测因素。这些发现对经导管和外科生物瓣主动脉瓣均适用。无患者出现瓣膜功能障碍症状，瓣叶增厚与任何临床事件均无明显相关性。
经导管主动脉瓣植入术和外科主动脉瓣置换术后，瓣叶亚临床血栓形成是一种常见发现，可能从正常瓣叶进展为更严重的 HALT，再进展为 HAM。该现象在瓣膜植入后可在不同时间间隔发展和消退。抗凝剂可能对 HALT 的发生有保护作用，但 HALT 也可在无抗凝治疗的情况下消退。
在 ClinicalTrials.gov 注册：NCT02426307。
