Systematic CT Methodology for the Evaluation of Subclinical Leaflet Thrombosis

JACC-CARDIOVASCULAR IMAGING

卷:10

Article

Jilaihawi, Hasan¹  Asch, Federico M.²  Manasse, Eric³  Ruiz, Carlos E.⁴  Jelnin, Vladimir⁴  Kashif, Mohammad⁵  Kawamori, Hiroyuki⁵  Maeno, Yoshio⁵  Kazuno, Yoshio⁵  Takahashi, Nobuyuki⁵  Olson, Richard³  Alkhatib, Joe⁵  Berman, Daniel⁵  Friedman, John⁵  Gellada, Norman⁵  Chakravarty, Tarun⁵  Makkar, Raj R.⁵ 

[1] NYU, Langone Med Ctr, Heart Valve Ctr, 530 1st Ave,Suite 9V, New York, NY 10016 USA

[2] Washington Hosp Ctr, MedStar Cardiovasc Res Network, Washington, DC 20010 USA

[3] St Jude Med, Minneapolis, MN USA

[4] Hackensack Univ, Med Ctr, Hackensack, NJ USA

[5] Cedars Sinai Heart Inst, Los Angeles, CA USA

关键词: aortic stenosis;    aortic valve replacement;    leaflet thrombosis;    transcatheter aortic valve implantation;    transcatheter aortic valve replacement;    TAVI;    TAVR;   

DOI  :  10.1016/j.jcmg.2017.02.005

来源: Elsevier

【 摘 要 】

Subclinical leaflet thrombosis was recently described in a randomized trial of transcatheter aortic valve replacement. It was subsequently demonstrated in a series of registries that this was a commonly observed imaging finding seen in all transcatheter and surgical bioprostheses. The phenomenon has aroused considerable interest due to the as-yet undefined risk for later clinical events and the possibility of pharmacological intervention with anticoagulation. Subclinical leaflet thrombosis is easily detected noninvasively by technically suitable computed tomography (CT) with a high degree of concordance to transesophageal echocardiography findings. The CT hallmarks were noted to be hypoattenuated leaflet thickening (HALT) associated with reduced leaflet motion (RELM). The combination of HALT and RELM signified hypoattenuation affecting motion, the standardized imaging endpoint used. This paper describes the systematic CT evaluation methodology that was devised during the Portico trial investigation and U.S. Food and Drug Administration submission; it also highlights the need for an ongoing discussion among experts to enable, with the help of the Valve Academic Research Consortium, standardization of reporting of this imaging finding to cater to the present and future needs of clinical trials. (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

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