Periprocedural Thrombogenicity Change Is Associated With Subclinical Leaflet Thrombosis Progression in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background: Subclinical leaflet thrombosis occasionally occurs after transcatheter aortic valve implantation (TAVI), but its exact etiology and relationship with thrombogenicity remain unknown. Methods and Results: This study enrolled 35 patients who underwent TAVI. Thrombogenicity was evaluated using a total thrombus-formation analysis system (T-TAS) to compute the thrombus-formation area under the curve (PL 18 -AUC 10 and AR 10 -AUC 30 ). Periprocedural thrombogenic parameters including T-TAS were investigated at pre-TAVI, 2 days, 7 days, and 3 months post-TAVI. Hypoattenuated leaflet thickening (HALT) and maximum leaflet thickness (MLT) were evaluated using contrast-enhanced computed tomography 7 days and 3 months post-TAVI. The associations between thrombogenicity and HALT or MLT were assessed. T-TAS parameters consistently decreased at 2 and 7 days post-TAVI, followed by improvement at 3 months. HALT was detected in 20% and 17% of patients at 7 days and 3 months, respectively, post-TAVI. The median MLT value was 1.60 mm at 7 days and 3 months post-TAVI. A significant positive correlation was observed between the decrease in the AR 10 -AUC 30 and MLT at 7 days post-TAVI. Univariate linear regression analysis revealed a decrease in the AR 10 -AUC 30 and an increase in the D-dimer level as a significant predictor of MLT deterioration. Conclusions: The findings suggested that a transient decrease in thrombogenicity following TAVI predicts leaflet thrombosis, implying that monitoring thrombogenicity may be useful for predicting progression of leaflet thrombosis.; Competing Interests: K.K., K.T. are members of Circulation Reports’ Editorial Team. K.K. received Grants-in-Aid for Scientific Research (20K08451) from the Ministry of Education, Culture, Sports, Science and Technology of Japan, received remuneration for lectures from Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., Novartis Pharma AG., Otsuka Pharmaceutical Co., Ltd., Bristol-Myers K.K., and Kowa Pharmaceutical Co. Ltd., received trust research/joint research funds from Bayer Yakuhin, Ltd., and Daiichi Sankyo Co., Ltd., and received scholarship funds from Abbott Medical Co., Ltd. K.T. received significant research grants from Bayer Yakuhin, Ltd., Bristol-Myers K.K., EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., CSL Behring K.K., JIMRO Co., Ltd., Alexion Pharmaceuticals, Inc., AnGes, Inc., PPD-Shin Nippon Biomedical Laboratories K.K., SUGI BEE GARDEN (International) Co., Ltd., Pfizer Japan Inc., scholarship funds from AMI Co., Ltd., Boehringer Ingelheim Japan, Daiichi Sankyo Co., Ltd., ONO Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Abbott Medical Co., Ltd., and ITI Co., Ltd. and honoraria from Amgen K.K., Abbott Medical Co., Ltd., AstraZeneca K.K., Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., Medtronic Japan Co., Ltd., Kowa Pharmaceutical Co. Ltd., Kyowa Kirin Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., and Janssen Pharmaceutical K.K., and belongs to endowed departments donated by Abbott Japan Co., Ltd., Boston Scientific Japan K.K., Fides-one, Inc., GM Medical Co., Ltd., ITI Co., Ltd., Kaneka Medix Co., Ltd., NIPRO Corporation, Terumo Co, Ltd., Abbott Medical Co., Ltd., Fukuda Denshi Co., Ltd., Japan Lifeline Co., Ltd., and Medtronic Japan Co., Ltd. (Copyright © 2023, THE JAPANESE CIRCULATION SOCIETY.)