Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

Lara Waldschmidt,Niklas Schofer,Hermann Reichenspurner,Moritz Seiffert,Lisa Voigtländer,Stefan Blankenberg,Sebastian Ludwig,Andreas Drolz,Matthias Linder,Paula Heimburg,Dirk Westermann,Johannes Kluwe,Alina Goßling,Lenard Conradi

doi:10.1007/s00392-021-01905-z

Abstract

BackgroundHeyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce.Methods2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde).ResultsA history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05).ConclusionA relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS.Graphic abstract

Highlights

The association of aortic valve stenosis (AS) and gastrointestinal bleeding (GIB) from angiodysplasia is known as Heyde syndrome (HS) [1]
Hemoglobin levels were lower in patients with HS compared to those with GIB unrelated to angiodysplasia (all results as follows Heyde vs. Non-Heyde, Hb 10.0 (8.7,11.1) g/dl vs. 10.8 (9.4,12.2) g/dl; p = 0.02, see Table 1)
Three key findings can be drawn from this retrospective single-center analysis: First, HS was prevalent in a relevant number of transcatheter aortic valve implantation (TAVI) patients (1.8%) which was in line with previously published data from smaller observational analyses [2,3,4,5]

Summary

Introduction

The association of aortic valve stenosis (AS) and gastrointestinal bleeding (GIB) from angiodysplasia is known as Heyde syndrome (HS) [1]. High shear stress caused by severe aortic stenosis leads to a decreased content of the high-molecular-weight multimers (HMWM) and decreased collagen-binding activity of VWF [7,8,9] The combination of both factors, vascular malformations, i.e. angiodysplasia, and hemostaseologic alterations due to AS, result in a higher bleeding risk in these patients [10]. Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS

Objectives

Methods

Results

Discussion

Conclusion