Background:This analysis evaluated echocardiographic predictors of hypoattenuated leaflet thickening (HALT) in low-risk patients undergoing transcatheter aortic valve replacement and assessed 1-year clinical and hemodynamic consequences. HALT by computed tomography may be associated with early valve degeneration and increased neurological events.Methods:Echocardiograms were performed at baseline, discharge, 30 days, and 1 year post-procedure. Four-dimensional contrast-enhanced computed tomography assessed HALT at 30 days. Independent core laboratories analyzed images. Doppler hemodynamic parameters were tested in a univariable regression model to identify HALT predictors. One-year clinical and hemodynamic outcomes were compared between HALT (+) and (−) patients.Results:Analysis included 170 patients with Sapien 3 valves and diagnostic 30-day computed tomographies, of whom 27 (16%) had HALT. Baseline characteristics were similar between groups. After transcatheter aortic valve replacement, aortic flow was nonsignificantly reduced in patients who developed HALT. Regression analysis did not show significant association between baseline or discharge valve hemodynamics and development of HALT at 30 days. Patients with HALT had smaller aortic valve areas (1.4±0.4 versus 1.7±0.5 cm²; P=0.018) and Doppler velocity index (0.4±0.1 versus 0.5±0.1; P=0.003) than those without HALT at 30 days but not at 1 year. There was no difference in aortic mean gradient at 30 days. There was no difference between the groups in New York Heart Association class, 6-minute walk distance, and mortality at 1 year.Conclusions:There were no early hemodynamic predictors of HALT. At 30 days, patients with HALT had worse valve hemodynamics than those without HALT, but hemodynamic and clinical outcomes at 1 year were similar.Clinical Trial Registration:URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628899.

中文翻译：

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接受导管主动脉瓣置换术的低风险患者的血流动力学和亚临床小叶血栓形成。

背景：本分析评估了经导管主动脉瓣置换的低危患者的超声心动图预测的低衰减小叶增厚（HALT），并评估了1年的临床和血液动力学后果。方法：在基线，出院，术后30天和术后1年行超声心动图检查。三维对比增强计算机断层扫描在30天时评估HALT。独立的核心实验室分析了图像。在单变量回归模型中测试多普勒血流动力学参数，以识别HALT预测因子。比较了HALT（+）和（−）患者的一年临床和血液动力学结果。分析包括170例Sapien 3瓣膜和30天诊断性X线断层扫描的患者，其中27例（16％）患有HALT。各组之间的基线特征相似。经导管主动脉瓣置换后，发生HALT的患者主动脉血流无明显减少。回归分析未显示基线或排出阀血流动力学与30天HALT发生之间显着相关。HALT患者的主动脉瓣面积较小（1.4±0.4对1.7±0.5 cm 回归分析未显示基线或排出阀血流动力学与30天HALT发生之间显着相关。HALT患者的主动脉瓣面积较小（1.4±0.4对1.7±0.5 cm 回归分析未显示基线或排出阀血流动力学与30天HALT发生之间显着相关。HALT患者的主动脉瓣面积较小（1.4±0.4对1.7±0.5 cm² ; P = 0.018）和多普勒速度指数（0.4±0.1对0.5±0.1；P = 0.003）比没有HALT但在1年时没有HALT的患者高。30天时主动脉平均梯度无差异。纽约心脏协会的班级，6分钟的步行距离和1岁时的死亡率之间没有差异。结论：没有早期HALT的血液动力学预测指标。在30天时，HALT患者的瓣膜血流动力学较未使用HALT的患者差，但1年时的血流动力学和临床结局相似。临床试验注册：URL：http://www.clinicaltrials.gov。唯一标识符：NCT02628899。