Subclinical leaflet thrombosis after transcatheter aortic valve implantation: no association with left ventricular reverse remodeling at 1-year follow-up

Laura Fusini,Andrea D Annoni,Nicolaj C Hansson,Jeroen J Bax,Federico Fortuni,Gurpreet K Singh,Juhani Knuuti,Steen H Poulsen,Gianluca Pontone,Bjarne L Nørgaard,Jurrien H Kuneman,Nina Ajmone Marsan,E Mara Vollema,Anders L D Pedersen,Victoria Delgado

doi:10.1007/s10554-021-02438-2

Abstract

Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves is detected on multidetector computed tomography (MDCT) and reflects leaflet thrombosis. Whether HALT affects left ventricular (LV) reverse remodeling, a favorable effect of LV afterload reduction after transcatheter aortic valve implantation (TAVI) is unknown. The aim of this study was to examine the association of HALT after TAVI with LV reverse remodeling. In this multicenter case–control study, patients with HALT on MDCT were identified, and patients without HALT were propensity matched for valve type and size, LV ejection fraction (LVEF), sex, age and time of scan. LV dimensions and function were assessed by transthoracic echocardiography before and 12 months after TAVI. Clinical outcomes (stroke or transient ischemic attack, heart failure hospitalization, new-onset atrial fibrillation, all-cause mortality) were recorded. 106 patients (age 81 ± 7 years, 55% male) with MDCT performed 37 days [IQR 32–52] after TAVI were analyzed (53 patients with HALT and 53 matched controls). Before TAVI, all echocardiographic parameters were similar between the groups. At 12 months follow-up, patients with and without HALT showed a significant reduction in LV end-diastolic volume, LV end-systolic volume and LV mass index (from 125 ± 37 to 105 ± 46 g/m2, p = 0.001 and from 127 ± 35 to 101 ± 27 g/m2, p < 0.001, respectively, p for interaction = 0.48). Moreover, LVEF improved significantly in both groups. In addition, clinical outcomes were not statistically different. Improvement in LVEF and LV reverse remodeling at 12 months after TAVI were not limited by HALT.

Highlights

Pressure overload of the left ventricle (LV) caused by severe aortic valve stenosis commonly leads to LV remodeling and LV hypertrophy [1, 2]
The antithrombotic regimen did not differ between patients with and without Hypo-attenuated leaflet thickening (HALT) before transcatheter aortic valve implantation (TAVI)
The main findings of the current study can be summarized as follows: (1) Patients with and without HALT showed a similar reduction in LV volumes, regression in LV mass, and improvement in LV ejection fraction (LVEF) at 12 months after TAVI; (2) Prosthetic valve hemodynamics were comparable between groups over time; (3) The number of clinical events after TAVI was low and not significantly different between patients with and without HALT

Summary

Introduction

Pressure overload of the left ventricle (LV) caused by severe aortic valve stenosis commonly leads to LV remodeling and LV hypertrophy [1, 2]. If left untreated, this is associated with a significantly increased risk of morbidity and mortality [3, 4]. Aortic valve replacement provides direct relief of the LV outflow obstruction. The myocardium may undergo a favorable process of LV reverse remodeling with reduction in LV volumes, regression of LV mass, and improvement in function [5,6,7,8]. LV mass regression after aortic valve replacement has been associated with improved survival [9, 10]. Data from the Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated that greater LV mass regression after transcatheter aortic valve

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