Spartera Marco, Ancona Francesco, Barletta Marta, Rosa Isabella, Stella Stefano, Marini Claudia, Italia Leonardo, Montorfano Matteo, Latib Azeem, Alfieri Ottavio, Margonato Alberto, Colombo Antonio, Agricola Eustachio
Echocardiography Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Echocardiography. 2018 Mar;35(3):337-345. doi: 10.1111/echo.13777. Epub 2017 Dec 21.
Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics.
To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected.
Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features.
Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Interestingly, the combination of mean aortic pressure gradient ≥20 mm Hg and leaflet thickening significantly improved the specificity of echocardiography for diagnosis of THV thrombosis (specificity 94%). On the other hand, echocardiographic diagnosis of THV endocarditis remained limited by very low sensitivity despite showing high specificity.
The combination of Doppler and leaflets parameters can improve the echocardiographic diagnosis of THV thrombosis in post-TAVI patients with suspicious symptoms, via a significant increase in the overall test specificity. This would potentially allow more rational gatekeeping to more expensive/invasive diagnostic examinations (eg, CT scan) or therapeutic trials (eg, unnecessary anticoagulation).
经导管心脏瓣膜血栓形成（THV-t）和心内膜炎（THV-e）是经导管主动脉瓣植入术（TAVI）后的相关并发症。经导管心脏瓣膜（THV）功能障碍的定义主要基于多普勒（狭窄/反流），而未考虑瓣叶特征。
评估在怀疑人工瓣膜并发症时，瓣叶超声心动图特征相对于多普勒的额外诊断价值。
在621例TAVI术后患者中，确定了128例可能存在瓣膜并发症的病例。最终诊断为THV-t的患者有13例（10%），诊断为THV-e的患者有8例（6%），其余107例（84%）未明确诊断为血栓形成/心内膜炎（THV-no）。我们在两个时间点（基线和随访）分析了传统的多普勒参数和瓣叶形态功能特征。
在检测THV-t时，多普勒参数和瓣叶参数均显示出高敏感性（敏感性92%）和低特异性（特异性范围为32%至74%）。有趣的是，平均主动脉压力梯度≥20 mmHg与瓣叶增厚相结合，显著提高了超声心动图诊断THV血栓形成的特异性（特异性94%）。另一方面，尽管THV心内膜炎的超声心动图诊断显示出高特异性，但其敏感性仍然很低，限制了诊断价值。
多普勒参数和瓣叶参数相结合，可以提高对有可疑症状的TAVI术后患者THV血栓形成的超声心动图诊断准确性，通过显著提高总体检测特异性实现。这可能会使对更昂贵/侵入性的诊断检查（如CT扫描）或治疗试验（如不必要的抗凝）的把关更加合理。
