Key result
Use of a self-expanding valve independently predicted a threefold higher risk of hypoattenuated leaflet thickening (OR 3.05) compared to other valve types in TAVR patients on dual antiplatelet therapy.
Why the study?
Although high residual platelet reactivity increases thrombotic risk after coronary stenting, its role in hypoattenuated leaflet thrombosis after TAVR remains unclear.
Does self-expanding valve use increase the risk of hypoattenuated leaflet thickening in TAVR patients treated with dual antiplatelet therapy?
Observational (n=169)
Single-blind
Yes
Does self-expanding valve use increase the risk of hypoattenuated leaflet thickening in TAVR patients treated with dual antiplatelet therapy?
Odds Ratio: 3.05 (95% CI 1.3–7.14)
p-value: p=0.010
In TAVR patients treated with DAPT, hypoattenuated leaflet thickening occurred in 22% of cases and was driven by procedural and anatomical factors such as valve type and size, rather than residual platelet reactivity.
Background/Objectives: Hypoattenuated leaflet thrombosis (HALT) is a frequent finding after transcatheter aortic valve replacement (TAVR). Although high residual platelet reactivity (HPR) increases thrombotic risk after coronary stent implantation, its role in HALT remains unclear. This study aimed to determine the incidence and predictors of HALT in TAVR patients treated with dual antiplatelet therapy, focusing on the impact of HPR. Methods: This was a prospective, multicenter observational study. Between June 2018 and February 2022 patients with symptomatic severe aortic stenosis undergoing successful TAVR and treated with dual antiplatelet therapy for 3 months were included. Platelet reactivity was assessed 1–3 months post-TAVR using either VerifyNow (72%) or the Multiplate Analyzer (28%). HALT was evaluated using contrast-enhanced multidetector computed tomography. Results: A total of 169 patients were included (mean age 81.5 ± 5 years; 51% female). The incidence of HALT was 22%. Independent predictors of HALT were self-expanding valve (OR 3.05; 95% CI, 1.30–7.14; p = 0.010). Protective factors included larger prosthesis size (OR 0.78; 95% CI, 0.65–0.93; p = 0.007), statin-treated dyslipidemia (OR 0.37; 95% CI, 0.16–0.88; p = 0.024), and higher creatinine clearance (OR 0.98; 95% CI, 0.96–1.00; p = 0.035). HALT incidence was similar in patients with and without HPR (23.7% vs. 33.6%; p = 0.29). No differences in clinical outcomes were observed at 1 year. Conclusions: HALT occurred in nearly one-quarter of TAVR patients treated with dual antiplatelet therapy and was unrelated to platelet reactivity. Valve characteristics, renal function, and statin-treated dyslipidemia were associated with HALT, highlighting the multifactorial nature of its development.
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Jiménez‐Quevedo et al. (2026) conducted an observational in Severe symptomatic aortic stenosis (n=169). Self-expanding valve vs. Other valve types (e.g., balloon-expandable valve) was evaluated on Hypoattenuated leaflet thickening (HALT) on CT (OR 3.05, 95% CI 1.30-7.14, p=0.010). Use of a self-expanding valve independently predicted a threefold higher risk of hypoattenuated leaflet thickening (OR 3.05) compared to other valve types in TAVR patients on dual antiplatelet therapy.
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