Grodecki Kajetan, Dey Damini, Geers Jolien, Kwiecinski Jacek, Tomasino Guadalupe Flores, Patel Vivek, Park Caroline, Xing Emily, Patel Dhairya, Suruga Kazuki, Gupta Aakriti, Nakamura Mamoo, Gheorghiu Mitch, Chakravarty Tarun, Berman Daniel, Slomka Piotr, Jilaihawi Hasan, Makkar Raj R
Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
EuroIntervention. 2025 May 5;21(9):e471-e481. doi: 10.4244/EIJ-D-24-01043.
Quantifying hypoattenuating leaflet thickening (HALT) on computed tomography angiography (CTA) may provide insights into its clinical implications and guide decisions on oral anticoagulation therapy following transcatheter aortic valve implantation (TAVI).
We sought to assess the association between quantitative CTA features of HALT and its evolution over time in a real-world cohort after TAVI.
Among 612 patients who underwent CTA 30 days post-TAVI with balloon-expandable bioprostheses, HALT was detected in 118 (19%). We prospectively followed 99 patients who had undergone a second CTA at 1 year to assess HALT progression. Thrombus volume and mean attenuation were quantified using semiautomated software, and various parameters of bioprosthetic deformation were analysed.
Complete resolution of HALT was observed in 43 patients. Multivariate logistic regression showed that lower thrombus attenuation was an independent predictor of HALT resolution (odds ratio [OR] 0.45; p=0.030), along with the eccentricity index (OR 0.42; p=0.003), deformation index (OR 0.53; p=0.005), and implant canting (OR 1.88; p=0.026). In the 56 patients without complete HALT resolution, thrombus evolution was visually categorised as regression (48%), stability (29%), or progression (23%). In a quantitative assessment, regression was associated with a significant decrease in thrombus volume (291 mm³ to 130 mm³; p=0.007), while progression showed an increase (187 mm³ to 667 mm³; p=0.005). The change in thrombus volume between 30 days and 1 year correlated with the magnitude of changes in mean transvalvular gradients over the same period (r=0.462; p<0.001).
Quantitative thrombus characterisation on CTA is predictive of HALT resolution and correlates with the haemodynamic performance of transcatheter aortic valves.
在计算机断层扫描血管造影（CTA）上对低密度瓣叶增厚（HALT）进行量化，可能有助于深入了解其临床意义，并为经导管主动脉瓣植入术（TAVI）后的口服抗凝治疗决策提供指导。
我们试图评估在一个真实世界队列中，TAVI后HALT的定量CTA特征与其随时间的演变之间的关联。
在612例接受球囊扩张生物假体TAVI术后30天进行CTA检查的患者中，118例（19%）检测到HALT。我们前瞻性地随访了99例在1年时接受第二次CTA检查以评估HALT进展的患者。使用半自动软件对血栓体积和平均衰减进行量化，并分析生物假体变形的各种参数。
43例患者的HALT完全消退。多因素逻辑回归显示，较低的血栓衰减是HALT消退的独立预测因素（比值比[OR]0.45；p=0.030），同时还有偏心指数（OR 0.42；p=0.003）、变形指数（OR 0.53；p=0.005）和植入倾斜度（OR 1.88；p=0.026）。在56例HALT未完全消退的患者中，血栓演变在视觉上分为消退（48%）、稳定（29%）或进展（23%）。在定量评估中，消退与血栓体积显著减少相关（291mm³至130mm³；p=0.007），而进展则显示增加（187mm³至667mm³；p=0.005）。30天至1年期间血栓体积的变化与同期平均跨瓣压差变化的幅度相关（r=0.462；p<0.001）。
CTA上的定量血栓特征可预测HALT的消退，并与经导管主动脉瓣的血流动力学性能相关。
