Abstract
Background
Hypo-attenuated leaflet thickening (HALT) may occur following transcatheter aortic
valve replacement (TAVR), however, it remains unclear if HALT is a predictor of haemodynamic
valve deterioration (HVD).
Aim
To determine the impact of HALT on the occurrence of HVD.
Methods
We prospectively evaluated 186 patients for the presence of HALT at a median of 6
weeks following TAVR (Interquartile-range [IQR] 4–12 weeks). HALT depth and area were
measured. HVD encompassed any of the following: mean gradient ≥20 mmHg with an increase
in gradient ≥10 mmHg from baseline, Doppler velocity index reduction ≥0.1 or new
moderate-to-severe valvular regurgitation. Routine echocardiograms at discharge, one
month and annually, were assessed by echo-cardiologists that were blinded to the HALT
status.
Results
LT prevalence was 17.7% (33/186). HVD was present in 8.6% (16/186) at a median follow-up
of 2 years (IQR 1–3); two required valve re-intervention and five required anticoagulation.
HALT was the only independent predictor of HVD on multivariate analysis (OR 33.3,
95%CI 7.4–125). Patients with HALT were more likely to develop HVD, require repeat
valve intervention and have higher trans-valvular gradients at up to 3-year follow-up.
Patients with HALT had a median cumulative thickness of 2.9 mm (IQR 1.9–4.7) and
area of 64.2 mm2 (IQR 40.9–91.6). Thresholds for HALT in predicting HVD were a cumulative depth of
2.4 mm (Specificity 94.1%, Sensitivity 75.0%, AUC = 0.87) and cumulative area of
28 mm2 (Specificity 92.2%, Sensitivity 81.3%, AUC = 0.86).
Conclusion
HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds
to predict HVD. CT following TAVR may determine patients at risk of HVD.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 25, 2021
Accepted:
November 24,
2021
Received in revised form:
November 10,
2021
Received:
October 8,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.
