{"title":"经导管主动脉瓣置入术后早期亚临床小叶血栓形成的远期影响。","authors":"Juri Iwata, Kentaro Hayashida, Ryo Arita, Tomonari Moriizumi, Akiyoshi Kajino, Shingo Sakata, Toshinobu Ryuzaki, Keitaro Shinada, Hikaru Tsuruta, Yoshitake Yamada, Jungo Kato, Tatsuo Takahashi, Masataka Yamazaki, Masahiro Jinzaki, Hideyuki Shimizu, Masaki Ieda","doi":"10.1002/ccd.31435","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm<sup>2</sup> vs. 1.72 ± 0.43 cm<sup>2</sup>; <i>p</i> = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm<sup>2</sup> vs. 1.45 ± 0.34 cm<sup>2</sup>; <i>p</i> = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83−1.70; <i>p</i> = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08−13.7; <i>p</i> = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89−5.99; <i>p</i> = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45−1.73; <i>p</i> = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203−2468) days.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1161-1170"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31435","citationCount":"0","resultStr":"{\"title\":\"Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation\",\"authors\":\"Juri Iwata, Kentaro Hayashida, Ryo Arita, Tomonari Moriizumi, Akiyoshi Kajino, Shingo Sakata, Toshinobu Ryuzaki, Keitaro Shinada, Hikaru Tsuruta, Yoshitake Yamada, Jungo Kato, Tatsuo Takahashi, Masataka Yamazaki, Masahiro Jinzaki, Hideyuki Shimizu, Masaki Ieda\",\"doi\":\"10.1002/ccd.31435\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm<sup>2</sup> vs. 1.72 ± 0.43 cm<sup>2</sup>; <i>p</i> = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm<sup>2</sup> vs. 1.45 ± 0.34 cm<sup>2</sup>; <i>p</i> = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83−1.70; <i>p</i> = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08−13.7; <i>p</i> = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89−5.99; <i>p</i> = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45−1.73; <i>p</i> = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203−2468) days.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.</p>\\n </section>\\n </div>\",\"PeriodicalId\":9650,\"journal\":{\"name\":\"Catheterization and Cardiovascular Interventions\",\"volume\":\"105 5\",\"pages\":\"1161-1170\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-02-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccd.31435\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31435\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31435","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：经导管主动脉瓣置入术（TAVI）后，多探测器计算机断层扫描（MDCT）检测到的小叶减薄增厚（HALT）被认为是小叶血栓形成。然而，其对长期临床结果的影响尚不清楚。本研究旨在探讨TAVI术后早期HALT检测对长期临床结果和6年以上结构性瓣膜恶化的影响。方法：在2013年至2018年期间连续接受TAVI的672例患者中，448例接受了SAPIEN XT或SAPIEN 3治疗，并在TAVI后30天内进行了MDCT分析。每年分析MDCT结果和超声心动图数据。结果：448例符合条件的患者中有68例（15.2%）在TAVI后30天内检测到HALT。在SAPIEN XT中，半停组和非半停组在TAVI后30天内的有效孔面积超声心动图无显著差异(半停组与非半停组：1.62±0.66 cm2 vs 1.72±0.43 cm2；组成3 p = 0.26)和(1.42±0.35厘米2和1.45±0.34平方厘米;p = 0.63)。全因死亡率无显著差异(52.9% vs. 60.0%；风险比（HR）： 1.19；95%置信区间（CI）： 0.83-1.70；P = 0.3)，卒中发生率(5.9% vs. 7.1%；人力资源:1.06;95% ci: 0.08-13.7；P = 0.97)，心力衰竭再住院(10.3% vs. 15.0%；人力资源:2.3;95% ci: 0.89-5.99；P = 0.09)，结构性瓣膜恶化(14.7% vs. 17.9%；人力资源:0.89;95% ci: 0.45-1.73；p = 0.73)，在1872个中位随访期间，HALT组和非HALT组之间观察到(四分位间距；1203 - 2468年)天。结论：在长期随访中，30天内的HALT与临床结果或血流动力学表现无关。
Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation
Background
Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.
Methods
Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.
Results
HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm2 vs. 1.72 ± 0.43 cm2; p = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm2 vs. 1.45 ± 0.34 cm2; p = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83−1.70; p = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08−13.7; p = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89−5.99; p = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45−1.73; p = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203−2468) days.
Conclusions
HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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