Hemodynamics and Subclinical Leaflet Thrombosis in Low-Risk Patients Undergoing Transcatheter Aortic Valve Replacement

被引：33

作者：

Khan, Jaffar M. ^{[1
,5
]}

Rogers, Toby ^{[1
,5
]}

Waksman, Ron ^{[1
]}

Torguson, Rebecca ^{[1
]}

Weissman, Gaby ^{[2
]}

Medvedofsky, Diego ^{[3
]}

Craig, Paige E. ^{[1
]}

Zhang, Cheng ^{[1
]}

Gordon, Paul ^{[6
]}

Ehsan, Afshin ^{[7
]}

Wilson, Sean R. ^{[8
]}

Goncalves, John ^{[9
]}

Levitt, Robert ^{[10
]}

Hahn, Chiwon ^{[11
]}

Parikh, Puja ^{[12
]}

Bilfinger, Thomas ^{[13
]}

Butzel, David ^{[14
]}

Buchanan, Scott ^{[14
]}

Hanna, Nicholas ^{[15
]}

Garrett, Robert ^{[16
]}

Shults, Christian ^{[4
]}

Garcia-Garcia, Hector M. ^{[1
]}

Kolm, Paul ^{[1
]}

Satler, Lowell F. ^{[1
]}

Buchbinder, Maurice ^{[17
]}

Ben-Dor, Itsik ^{[1
]}

Asch, Federico M. ^{[3
]}

机构：

[1] Medstar Washington Hosp Ctr, Sect Intervent Cardiol, Washington, DC USA

[2] Medstar Washington Hosp Ctr, Dept Cardiol, Washington, DC USA

[3] Medstar Washington Hosp Ctr, MedStar Hlth Res Inst, Washington, DC USA

[4] Medstar Washington Hosp Ctr, Dept Cardiac Surg, Washington, DC USA

[5] NHLBI, Cardiovasc Branch, Div Intramural Res, NIH, Bldg 10, Bethesda, MD 20892 USA

[6] Miriam Hosp, Div Cardiol, Providence, RI 02906 USA

[7] Lifespan Cardiovasc Inst, Div Cardiothorac Surg, Providence, RI USA

[8] Valley Hosp, Dept Med, Ridgewood, NJ USA

[9] Valley Hosp, Cardiac Surg Program, Ridgewood, NJ USA

[10] Henrico Doctors Hosp, Dept Cardiol, Richmond, VA USA

[11] Henrico Doctors Hosp, Dept Cardiothorac Surg, Richmond, VA USA

[12] Stony Brook Hosp, Dept Med, Stony Brook, NY USA

[13] Stony Brook Hosp, Dept Surg, Stony Brook, NY USA

[14] Maine Med Ctr, Cardiovasc Serv Line, Portland, ME 04102 USA

[15] St John Hlth Syst, St John Heart Inst Cardiovasc Consultants, Tulsa, OK USA

[16] St John Hlth Syst, St John Heart Inst Cardiovasc Consultants, St John Clin Cardiovasc Surg, Tulsa, OK USA

[17] Stanford Univ, Fdn Cardiovasc Med, Stanford, CA 94305 USA

来源：

CIRCULATION-CARDIOVASCULAR IMAGING | 2019年 / 12卷 / 12期

关键词：

aortic valve; echocardiography; hemodynamics; regression analysis; transcatheter aortic valve replacement; STENOSIS;

D O I：

10.1161/CIRCIMAGING.119.009608

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: This analysis evaluated echocardiographic predictors of hypoattenuated leaflet thickening (HALT) in low-risk patients undergoing transcatheter aortic valve replacement and assessed 1-year clinical and hemodynamic consequences. HALT by computed tomography may be associated with early valve degeneration and increased neurological events. Methods: Echocardiograms were performed at baseline, discharge, 30 days, and 1 year post-procedure. Four-dimensional contrast-enhanced computed tomography assessed HALT at 30 days. Independent core laboratories analyzed images. Doppler hemodynamic parameters were tested in a univariable regression model to identify HALT predictors. One-year clinical and hemodynamic outcomes were compared between HALT (+) and (-) patients. Results: Analysis included 170 patients with Sapien 3 valves and diagnostic 30-day computed tomographies, of whom 27 (16%) had HALT. Baseline characteristics were similar between groups. After transcatheter aortic valve replacement, aortic flow was nonsignificantly reduced in patients who developed HALT. Regression analysis did not show significant association between baseline or discharge valve hemodynamics and development of HALT at 30 days. Patients with HALT had smaller aortic valve areas (1.4 +/- 0.4 versus 1.7 +/- 0.5 cm(2); P=0.018) and Doppler velocity index (0.4 +/- 0.1 versus 0.5 +/- 0.1; P=0.003) than those without HALT at 30 days but not at 1 year. There was no difference in aortic mean gradient at 30 days. There was no difference between the groups in New York Heart Association class, 6-minute walk distance, and mortality at 1 year. Conclusions: There were no early hemodynamic predictors of HALT. At 30 days, patients with HALT had worse valve hemodynamics than those without HALT, but hemodynamic and clinical outcomes at 1 year were similar.

引用

页数：9

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