Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, Chengdu, 610041, People's Republic of China.
Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
J Thromb Thrombolysis. 2018 Apr;45(3):463-465. doi: 10.1007/s11239-018-1636-z.
The imaging finding of hypo-attenuated leaflet thickening (HALT) on bioprosthesis after transcatheter aortic valve replacement (TAVR) has been reported. The underlying mechanism is not clear, but leaflet thrombosis is speculated to be the cause. Heterogeneous antiplatelet responses may play a role in the process. This is a prospective, single-center pilot study in patients who received successful TAVR from June 2012 to November 2016. HALT on post-procedural multi-detector computed tomography. We thoroughly genotyped 34 SNPs and 8 SNPs that have been reported for clopidogrel and aspirin resistance. A total of 148 patients were enrolled. There were 15 patients demonstrating signs of HALT. Patients with HALT had a higher rate of atrial fibrillation (AF) pre-TAVR (33.3 vs. 7.5%, P = 0.01). We found that rs4244285 G>A polymorphism of the CYP2C19 gene was associated with the risk of HALT in the overdominant model (OR 4.00 [1.15-13.97], P = 0.02 for GA vs. GG+AA) adjusted by sex and the presence of pre-TAVR AF. Antiplatelet drug resistance is a reasonable possibility involved in HALT. Potential directions were suggested in polymorphisms of the CYP2C19 gene.
经导管主动脉瓣置换术（TAVR）后生物瓣低衰减瓣叶增厚（HALT）的影像学发现已有报道。其潜在机制尚不清楚，但推测瓣叶血栓形成是其原因。血小板反应的异质性可能在该过程中发挥作用。这是一项前瞻性、单中心的研究，研究对象为 2012 年 6 月至 2016 年 11 月接受成功 TAVR 的患者。术后多探测器计算机断层扫描发现 HALT。我们彻底对 34 个 SNP 和 8 个与氯吡格雷和阿司匹林抵抗相关的已报道 SNP 进行了基因分型。共纳入 148 例患者，其中 15 例患者出现 HALT 征象。有 HALT 的患者在 TAVR 前心房颤动（AF）的发生率更高（33.3%比 7.5%，P=0.01）。我们发现 CYP2C19 基因 rs4244285 G>A 多态性与 GA 模型（GA 比 GG+AA 的优势比[OR] 4.00 [1.15-13.97]，P=0.02）中 HALT 的风险相关，该模型经过性别和 TAVR 前 AF 的调整。抗血小板药物抵抗是 HALT 涉及的一个合理可能性。CYP2C19 基因多态性提示了潜在的方向。
