Grodecki Kajetan, Pawlak Katarzyna, Grodecka Matylda, Rymuza Bartosz, Scislo Piotr, Ciepiela Olga, Kochman Janusz, Huczek Zenon
1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.
Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.
J Cardiovasc Dev Dis. 2025 Feb 6;12(2):62. doi: 10.3390/jcdd12020062.
Subclinical leaflet thrombosis is an imaging phenomenon observed after transcatheter aortic valve implantation (TAVI) and characterized by hypoattenuating leaflet thickening (HALT) on computed tomography angiography. The clinical implications and underlying causes remain uncertain. Hypercoagulability, a component of Virchow's triad, may contribute to thrombus formation on bioprosthetic leaflets, but data on hypercoagulable disorders in TAVI patients and their impact on HALT are limited. The PROSTHESIS study (Prothrombotic States in Transcatheter Heart Valve Subclinical Leaflet Thrombosis) is a single-center observational cohort study aiming to include 130 TAVI patients. This pilot study aimed to (i) assess the effect of hypercoagulable disorders on HALT prevalence and (ii) evaluate their impact on the natural history of HALT. Patients were screened for common hypercoagulable disorders using genetic and functional assays and underwent multimodal imaging one year after TAVI to detect HALT. In patients with HALT, post-implant imaging was repeated after three months to assess its progression. Early results comparing 52 TAVI patients with 52 matched controls undergoing coronary angiography showed similar thrombophilia prevalence between the groups (16% vs. 12%, = 0.565). HALT occurred in 15% of TAVI patients, more extensively in those with thrombophilia (712 mm vs. 135 mm, = 0.036). However, thrombophilia was not an independent predictor of HALT. One-year follow-up CTA revealed spontaneous HALT resolution in 63%, stability in 25%, and progression in 12%. This study aims to provide insights into HALT and its mechanisms, which may help prevent complications and improve bioprosthesis durability.
亚临床瓣叶血栓形成是经导管主动脉瓣植入术（TAVI）后观察到的一种影像学现象，其特征是在计算机断层血管造影上表现为瓣叶增厚伴低密度影（HALT）。其临床意义和潜在病因仍不明确。高凝状态是维勒布兰德氏三联征的一个组成部分，可能导致生物瓣叶上形成血栓，但关于TAVI患者高凝性疾病及其对HALT影响的数据有限。PROSTHESIS研究（经导管心脏瓣膜亚临床瓣叶血栓形成中的血栓前状态）是一项单中心观察性队列研究，旨在纳入130例TAVI患者。这项初步研究旨在（i）评估高凝性疾病对HALT患病率的影响，以及（ii）评估它们对HALT自然病程的影响。使用基因和功能检测方法对患者进行常见高凝性疾病筛查，并在TAVI术后一年进行多模态成像以检测HALT。对于出现HALT的患者，在三个月后重复植入后成像以评估其进展情况。将52例TAVI患者与52例接受冠状动脉造影的匹配对照进行比较的早期结果显示，两组之间血栓形成倾向患病率相似（16%对12%，P = 0.565）。15%的TAVI患者出现HALT，血栓形成倾向患者中更为广泛（712毫米对135毫米，P = 0.036）。然而，血栓形成倾向并非HALT的独立预测因素。一年随访CTA显示，63%的患者HALT自发消退，25%稳定，12%进展。本研究旨在深入了解HALT及其机制，这可能有助于预防并发症并提高生物瓣的耐久性。
