Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR

Ryo Yanagisawa, Kentaro Hayashida, Yoshitake Yamada, Makoto Tanaka, Fumiaki Yashima, Taku Inohara, Takahide Arai, Takashi Kawakami, Yuichiro Maekawa, Hikaru Tsuruta, Yuji Itabashi, Mitsushige Murata, Motoaki Sano, Kazuma Okamoto, Akihiro Yoshitake, Hideyuki Shimizu, Masahiro Jinzaki, Keiichi Fukuda

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume10
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Thrombosis
Multidetector Computed Tomography
Bioprosthesis
Incidence
Sinus of Valsalva
Aortic Valve
Anticoagulants
Registries
Hemodynamics
Stroke
Equipment and Supplies
Mortality
Therapeutics
fibrin fragment D

Keywords

  • aortic stenosis
  • D-dimer
  • reduced leaflet motion
  • TAVR
  • thrombosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR. / Yanagisawa, Ryo; Hayashida, Kentaro; Yamada, Yoshitake; Tanaka, Makoto; Yashima, Fumiaki; Inohara, Taku; Arai, Takahide; Kawakami, Takashi; Maekawa, Yuichiro; Tsuruta, Hikaru; Itabashi, Yuji; Murata, Mitsushige; Sano, Motoaki; Okamoto, Kazuma; Yoshitake, Akihiro; Shimizu, Hideyuki; Jinzaki, Masahiro; Fukuda, Keiichi.

In: JACC: Cardiovascular Imaging, Vol. 10, No. 1, 01.01.2017, p. 1-11.

Research output: Contribution to journalArticle

Yanagisawa, R, Hayashida, K, Yamada, Y, Tanaka, M, Yashima, F, Inohara, T, Arai, T, Kawakami, T, Maekawa, Y, Tsuruta, H, Itabashi, Y, Murata, M, Sano, M, Okamoto, K, Yoshitake, A, Shimizu, H, Jinzaki, M & Fukuda, K 2017, 'Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR', JACC: Cardiovascular Imaging, vol. 10, no. 1, pp. 1-11. https://doi.org/10.1016/j.jcmg.2016.11.005
Yanagisawa, Ryo ; Hayashida, Kentaro ; Yamada, Yoshitake ; Tanaka, Makoto ; Yashima, Fumiaki ; Inohara, Taku ; Arai, Takahide ; Kawakami, Takashi ; Maekawa, Yuichiro ; Tsuruta, Hikaru ; Itabashi, Yuji ; Murata, Mitsushige ; Sano, Motoaki ; Okamoto, Kazuma ; Yoshitake, Akihiro ; Shimizu, Hideyuki ; Jinzaki, Masahiro ; Fukuda, Keiichi. / Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR. In: JACC: Cardiovascular Imaging. 2017 ; Vol. 10, No. 1. pp. 1-11.
@article{0bc7c7651e6e40679621a3cf8cc842e8,
title = "Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR",
abstract = "Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4{\%}) at discharge, 7 (10.0{\%}) at 6 months, and 10 (14.3{\%}) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70{\%} vs. 25{\%}; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1{\%} vs. 33.3{\%}; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0{\%} vs. 1.7{\%}; p = 1.00) and stroke (0{\%} vs. 0{\%}; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.",
keywords = "aortic stenosis, D-dimer, reduced leaflet motion, TAVR, thrombosis",
author = "Ryo Yanagisawa and Kentaro Hayashida and Yoshitake Yamada and Makoto Tanaka and Fumiaki Yashima and Taku Inohara and Takahide Arai and Takashi Kawakami and Yuichiro Maekawa and Hikaru Tsuruta and Yuji Itabashi and Mitsushige Murata and Motoaki Sano and Kazuma Okamoto and Akihiro Yoshitake and Hideyuki Shimizu and Masahiro Jinzaki and Keiichi Fukuda",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jcmg.2016.11.005",
language = "English",
volume = "10",
pages = "1--11",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR

AU - Yanagisawa, Ryo

AU - Hayashida, Kentaro

AU - Yamada, Yoshitake

AU - Tanaka, Makoto

AU - Yashima, Fumiaki

AU - Inohara, Taku

AU - Arai, Takahide

AU - Kawakami, Takashi

AU - Maekawa, Yuichiro

AU - Tsuruta, Hikaru

AU - Itabashi, Yuji

AU - Murata, Mitsushige

AU - Sano, Motoaki

AU - Okamoto, Kazuma

AU - Yoshitake, Akihiro

AU - Shimizu, Hideyuki

AU - Jinzaki, Masahiro

AU - Fukuda, Keiichi

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.

AB - Objectives This study sought to clarify the incidence and predictors of hypoattenuated leaflet thickening (HALT) and mid-term outcomes after transcatheter aortic valve replacement. Background HALT detected on multidetector computed tomography (MDCT) scanning raised concerns about possible subclinical leaflet thrombosis. Methods We studied 70 of 100 consecutive patients from a single-center registry who underwent implantation with the Edwards SAPIEN-XT device. MDCT results, echocardiographic data, and laboratory findings obtained at the 6-month and 1-year follow-ups were analyzed. Results Of 70 patients, MDCT scans revealed HALT in 1 patient (1.4%) at discharge, 7 (10.0%) at 6 months, and 10 (14.3%) at 1 year post–transcatheter aortic valve replacement cumulatively. The degree of leaflet immobility correlated with the HALT area on 4-dimensional MDCT (r = 0.68) on the basis of data from 10 patients. HALT was associated with male sex (70% vs. 25%; p = 0.008) and larger sinus of Valsalva (31.0 ± 2.0 mm vs. 28.6 ± 2.6 mm; p = 0.005). HALT was found in 3 of 49 patients with a 23-mm bioprosthesis and in 7 of 21 patients with a 26-mm bioprosthesis (6.1% vs. 33.3%; p = 0.006). D-dimer levels were significantly increased in the HALT group at the 6-month (2.3 μg/ml [interquartile range (IQR): 2.1 to 6.1 μg/ml] vs. 1.1 μg/ml [IQR: 0.8 to 2.2 μg/ml]; p = 0.002) and 1-year (2.7 μg/ml [IQR: 1.7 to 4.8 μg/ml] vs. 1.2 μg/ml [IQR: 0.9 to 2.1 μg/ml]; p = 0.006) follow-ups, despite no differences at discharge. The pressure gradient was decreased in the HALT group at the 1-year follow-up (8.3 ± 0.8 mm Hg vs. 11.1 ± 4.9 mm Hg; p = 0.005). After detecting HALT, additional anticoagulation therapy was not administered. Clinical outcomes, including all-cause mortality (0% vs. 1.7%; p = 1.00) and stroke (0% vs. 0%; p = 1.00), were similar between the groups. Conclusions HALT with reduced leaflet motion was not rare but usually subclinical. Valve hemodynamics and mid-term outcomes were uneventful even without additional anticoagulant therapy in our limited number of cases. Male sex, larger sinus and bioprosthesis size, and elevated D-dimer levels during follow-up were associated with this phenomenon.

KW - aortic stenosis

KW - D-dimer

KW - reduced leaflet motion

KW - TAVR

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85009094275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009094275&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2016.11.005

DO - 10.1016/j.jcmg.2016.11.005

M3 - Article

AN - SCOPUS:85009094275

VL - 10

SP - 1

EP - 11

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 1

ER -