经导管主动脉瓣植入术后早期亚临床瓣叶血栓形成的长期影响
Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation.
作者信息
Iwata Juri, Hayashida Kentaro, Arita Ryo, Moriizumi Tomonari, Kajino Akiyoshi, Sakata Shingo, Ryuzaki Toshinobu, Shinada Keitaro, Tsuruta Hikaru, Yamada Yoshitake, Kato Jungo, Takahashi Tatsuo, Yamazaki Masataka, Jinzaki Masahiro, Shimizu Hideyuki, Ieda Masaki
机构信息
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
出版信息
Catheter Cardiovasc Interv. 2025 Apr;105(5):1161-1170. doi: 10.1002/ccd.31435. Epub 2025 Feb 3.
BACKGROUND
Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.
METHODS
Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.
RESULTS
HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm vs. 1.72 ± 0.43 cm; p = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm vs. 1.45 ± 0.34 cm; p = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83-1.70; p = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08-13.7; p = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89-5.99; p = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45-1.73; p = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203-2468) days.
CONCLUSIONS
HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.
背景
在多排螺旋计算机断层扫描（MDCT）上检测到的经导管主动脉瓣植入术（TAVI）后瓣叶低密度增厚（HALT）被认为是瓣叶血栓形成。然而，其对长期临床结局的影响仍不明确。本研究旨在调查TAVI后早期检测到HALT对6年以上长期临床结局和瓣膜结构恶化的影响。
方法
在2013年至2018年间连续接受TAVI的672例患者中，448例接受了SAPIEN XT或SAPIEN 3治疗，并在TAVI后30天内接受了MDCT分析。每年分析MDCT结果和超声心动图数据。
结果
448例符合条件的患者中，68例（15.2%）在TAVI后30天内检测到HALT。在SAPIEN XT组中，TAVI后30天内HALT组和非HALT组之间通过超声心动图观察到的有效瓣口面积无显著差异（HALT组 vs. 非HALT组：1.62±0.66 cm vs. 1.72±0.43 cm；p = 0.26），SAPIEN 3组中也无显著差异（1.42±0.35 cm vs. 1.45±0.34 cm；p = 0.63）。在1872天（四分位间距；1203 - 2468天）的中位随访期间，HALT组和非HALT组在全因死亡率（52.9% vs. 60.0%；风险比（HR）：1.19；95%置信区间（CI）：0.83 - 1.70；p = 0.3）、中风发生率（5.9% vs. 7.1%；HR：1.06；95% CI：0.08 - 13.7；p = 0.97）、心力衰竭再住院率（10.3% vs. 15.0%；HR：2.3；95% CI：0.89 - 5.99；p = 0.09）和瓣膜结构恶化（14.7% vs. 17.9%；HR：0.89；95% CI：0.45 - 1.73；p = 0.73）方面均未观察到显著差异。
结论
30天内的HALT与长期随访期间的临床结局或血流动力学表现无关。
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