Zhou Qijing, Wen Jiaqi, Zhu Qifeng, Fan Jiaqi, Guan Xiaojun, Chen Xinyi, He Yuxin, Guo Yuchao, Jiang Jubo, Ding Xinfa, Pu Zhaoxia, Huang Zhaoxu, Li Cheng, Zhang Minming, Liu Xianbao, Xu Xiaojun, Wang Jian'an
Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Insights Imaging. 2024 May 30;15(1):125. doi: 10.1186/s13244-024-01681-0.
To observe prosthetic-associated subclinical thrombotic events (PASTE) after transcatheter aortic valve implantation (TAVI) by cardiac CTA, and assess their impact on long-term patient outcomes.
We prospectively and consecutively enrolled 188 patients with severe aortic stenosis treated with TAVI from February 2014 to April 2017. At 5 years, 61 of 141 survived patients who had completed annual follow-up CTA (≥ 5 years) were included. We analyzed PASTE by CTA, including hypoattenuated leaflet thickening (HALT), sinus filling defect (SFD), and prosthesis filling defect (PFD). The primary outcome was a major adverse cardiovascular composite outcome (MACCO) of stroke, cardiac re-hospitalization, and bioprosthetic valve dysfunction (BVD); the secondary outcomes were bioprosthetic hemodynamics deterioration (PGmean) and cardiac dysfunction (LVEF).
During a median follow-up time of 5.25 years, long-term incidence of HALT, SFD, and PFD were 54.1%, 37.7%, and 73.8%, respectively. In the primary outcome, SFD and early SFD were associated with the MACCO (SFD: p = 0.005; early SFD: p = 0.018), and SFD was a predictor of MACCO (HR: 2.870; 95% CI: 1.010 to 8.154, p = 0.048). In the secondary outcomes, HALT was associated with increased PGmean (p = 0.031), while persistent HALT was correlated with ΔPGmean (β = 0.38, p = 0.035). SFD was negatively correlated with ΔLVEF (β = -0.39, p = 0.041), and early SFD was negatively correlated with LVEF and ΔLVEF (LVEF: r = -0.50, p = 0.041; ΔLVEF: r = -0.53, p = 0.030).
PASTE were associated with adverse long-term outcomes, bioprosthetic hemodynamics deterioration, and cardiac dysfunction. In particular, SFD was a predictor of MACCO and may be a potential target for anticoagulation after TAVI (NCT02803294).
URL: https://www.
gov ; Unique identifier: NCT02803294.
PASTE, especially SFD, after TAVI based on cardiac CTA findings impacts the long-term outcomes of patients which is a predictor of long-term major adverse outcomes in patients and may be a potential target for anticoagulation after TAVI.
Transcatheter aortic valve implantation is being used more often; associated subclinical thromboses have not been thoroughly evaluated. Prosthetic-associated subclinical thrombotic events were associated with adverse outcomes, bioprosthetic hemodynamics deterioration, and cardiac dysfunction. Studies should be directed at these topics to determine if they should be intervened upon.
通过心脏CT血管造影（CTA）观察经导管主动脉瓣植入术（TAVI）后与人工瓣膜相关的亚临床血栓形成事件（PASTE），并评估其对患者长期预后的影响。
我们前瞻性连续纳入了2014年2月至2017年4月接受TAVI治疗的188例严重主动脉瓣狭窄患者。在5年时，纳入了141例存活且完成年度随访CTA（≥5年）的患者中的61例。我们通过CTA分析PASTE，包括低密度瓣叶增厚（HALT）、窦部充盈缺损（SFD）和人工瓣膜充盈缺损（PFD）。主要结局是卒中、心脏再次住院和生物人工瓣膜功能障碍（BVD）的主要不良心血管复合结局（MACCO）；次要结局是生物人工瓣膜血流动力学恶化（平均压差，PGmean）和心脏功能障碍（左心室射血分数，LVEF）。
在中位随访时间5.25年期间，HALT、SFD和PFD的长期发生率分别为54.1%、37.7%和73.8%。在主要结局中，SFD和早期SFD与MACCO相关（SFD：p = 0.005；早期SFD：p = 0.018），且SFD是MACCO的预测因素（风险比：2.870；95%置信区间：1.010至8.154，p = 0.048）。在次要结局中，HALT与PGmean升高相关（p = 0.031），而持续性HALT与PGmean的变化量相关（β = 0.38，p = 0.035）。SFD与LVEF的变化量呈负相关（β = -0.39，p = 0.041），早期SFD与LVEF及LVEF的变化量呈负相关（LVEF：r = -0.50，p = 0.041；LVEF的变化量：r = -0.53，p = 0.030）。
PASTE与不良长期结局、生物人工瓣膜血流动力学恶化和心脏功能障碍相关。特别是，SFD是MACCO的预测因素，可能是TAVI后抗凝治疗的潜在靶点（NCT02803294）。
网址：https://www.
gov；唯一标识符：NCT02803294。
基于心脏CTA结果，TAVI后的PASTE，尤其是SFD，会影响患者的长期预后，是患者长期主要不良结局的预测因素，可能是TAVI后抗凝治疗的潜在靶点。
经导管主动脉瓣植入术的应用越来越频繁；相关亚临床血栓形成尚未得到充分评估。与人工瓣膜相关的亚临床血栓形成事件与不良结局、生物人工瓣膜血流动力学恶化和心脏功能障碍相关。应针对这些主题开展研究，以确定是否需要进行干预。
