Associations of biomarkers with hypoattenuated leaflet thickening after transcatheter aortic valve replacement

Q: What does this research mean for the field?

Hemostatic and inflammatory biomarkers do not demonstrate statistically significant associations with hypoattenuated leaflet thickening after transcatheter aortic valve replacement once adjusted for multiple testing. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

David Hesselbarth; Michelle D’Orazio; G. Ciccarone; Diona Gjermeni; Carina Jülch; Philipp Breitbart; Philipp Ruile; Manuel Hein; Marius Wessinger; Mariya Maslarska; Jonathan Rilinger; Christopher Schlett; Fabian Bamberg; Klaus Kaier; Daniel Duerschmied; Torben Pottgießer; Constantin von zur Mühlen; Dirk Westermann; Christoph B. Olivier

doi:10.1016/j.rpth.2025.103341

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Why the study?

Patients after TAVR have a high incidence of hypoattenuating leaflet thickening (HALT), but data on biomarkers related to HALT remain limited.

Are early post-TAVR biomarkers of hypercoagulability and inflammation associated with the development of moderate-to-severe hypoattenuated leaflet thickening (HALT) or reduced leaflet motion (RLM) at 6 months?

Structured PICO

Are early post-TAVR biomarkers of hypercoagulability and inflammation associated with the development of moderate-to-severe hypoattenuated leaflet thickening (HALT) or reduced leaflet motion (RLM) at 6 months?

P

Population

107 adult patients following transcatheter aortic valve replacement (TAVR), median age 82, 51% male. Key exclusions: severe renal insufficiency (eGFR < 30 mL/min/1.73 m2), severe thrombocytopenia (<50 × 10^3/μL), or undergoing Valve-in-Valve TAVR.

I

Intervention

Assessment of functional hemostatic profiles and blood biomarkers (using thrombelastography [TEG], light transmission aggregometry [LTA], and standard laboratory markers) evaluated once during the index hospitalization (days 1-17 post-TAVR; median day 4).

O

Outcome

Presence of at least 1 prosthetic valve leaflet with moderate-to-severe hypoattenuating leaflet thickening (HALT grade 3 or 4) or moderate-to-severe reduced leaflet motion (RLM grade 2 or 3) assessed by computed tomography angiography (CTA) at 6 months.surrogate

Early post-TAVR markers of hypercoagulability and inflammation showed numerical associations with subsequent hypoattenuating leaflet thickening, but these findings were non-significant after multiple testing correction and remain hypothesis-generating.

Limitations

Small sample size reducing statistical power
Single time-point measurement near discharge with variable post-TAVR clinical conditions precluding temporal change assessment
Absence of follow-up CTA in some patients may have introduced bias, as healthier patients were more likely to attend follow-up

Implication

No immediate change to post-TAVR management; leaves open whether hemostatic markers predict HALT or guide therapy.

Abstract

Background: Patients after transcatheter aortic valve replacement (TAVR) have a high incidence of hypoattenuating leaflet thickening (HALT). However, data on biomarkers related to HALT remain limited. Objectives: To identify hemostatic markers associated with HALT following TAVR. Methods: This prospective single-center cohort study assessed hemostatic profiles of patients undergoing TAVR between November 2020 and June 2022 using thrombelastography, light transmission aggregometry, and conventional laboratory markers. The primary outcome was moderate-to-severe HALT (grade 3/4) or reduced leaflet motion (grade 2/3) detected by computed tomography angiography at 6 months post-TAVR. Results: = .05) also demonstrated associations with HALT. However, after adjustment for multiple testing using the Benjamini-Hochberg procedure, none of these associations was statistically significant. Conclusion: This exploratory study identified associations between HALT and biomarkers of hypercoagulability and inflammation, which did not persist after correction for multiple testing. These findings should be regarded as hypothesis-generating and warrant confirmation in future studies.

Discussion

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Cite This Study

Hesselbarth et al. (2025) studied this question.

synapsesocial.com/papers/6a77ded2e29fd788c9f7a2a7 https://doi.org/10.1016/j.rpth.2025.103341

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Associations of biomarkers with hypoattenuated leaflet thickening after transcatheter aortic valve replacement

Figures

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Associations of biomarkers with hypoattenuated leaflet thickening after transcatheter aortic valve replacement

Figures

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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