Potential role of closure time with adenosine diphosphate in the diagnosis of mitral prosthetic paravalvular leak and prognosis after repair

Abstract

INTRODUCTION AND OBJECTIVES Mitral paravalvular leak (PVL) is associated with hemolysis and heart failure. It has also been linked to shear stress-induced von Willebrand factor abnormalities that prolong closure time with adenosine diphosphate (CT-ADP). The aim of this study was to assess whether CT-ADP serves as a biomarker for mitral PVL diagnosis, follow-up, and prognosis after repair. METHODS In this prospective study, 89 patients (27 with moderate-to-severe mitral PVL referred for closure, group 1; 31 with prosthetic mitral valves without PVL, group 2; and 31 controls without valvular disease, group 3) underwent laboratory assessment including hemolysis markers, congestion markers, and CT-ADP. Patients with PVL underwent percutaneous or surgical repair and were followed up at 3 and 12 months. ROC analysis, linear regression, and Cox models were used to evaluate the diagnostic and prognostic value of CT-ADP. RESULTS CT-ADP was prolonged in PVL patients (median, 214seconds) vs control groups (86 seconds in group 2 and 74seconds in group 3; P 135seconds showed excellent diagnostic accuracy (AUROC, 0.96; sensitivity 89%, specificity 97%). Postprocedural CT-ADP decreased significantly after successful repair (median decrease of 79seconds) but remained unchanged in those with residual leaks. Elevated postprocedural CT-ADP (>155 s) identified persistent PVL and was associated with worse 1-year outcomes (HR, 21.37; P=.004), including death, heart failure or hemolysis-related readmission, and reintervention. CONCLUSIONS CT-ADP appears to be a promising biomarker for diagnosing and monitoring mitral PVL. It may add value to conventional markers by reflecting shear stress-related platelet dysfunction and predicting outcomes following PVL closure.