Mitral annular calcification (MAC) is a degenerative process that causes calcium deposits along the mitral annulus. The pathophysiological mechanisms contributing to the development of MAC are not fully understood. The main risk factors for MAC are advanced age, female gender, chronic kidney disease, and conditions predisposing to left ventricular hypertrophy, which increases mitral annulus tension and subsequent annular degeneration. The prevalence of MAC varies widely among studies, from 5% to 42%, depending on the characteristics of the study population and the imaging modality used to make the diagnosis, and it is increasing over time. MAC is independently associated with all-cause mortality, cardiovascular mortality, and the occurrence of cardiovascular disease such as atrial fibrillation, conduction abnormalities, or stroke. MAC can progress and involve the mitral valve leaflets, causing mitral stenosis, mitral regurgitation, or both. Patients who develop symptomatic mitral valve dysfunction associated with significant MAC have lower survival when mitral valve intervention is not performed. However, the surgical risk of these patients is often high, precluding surgery in many. Therefore, transcatheter mitral valve implantation is emerging as an alternative in patients with severe MAC and associated symptomatic mitral valve dysfunction. This manuscript summarizes a description of the disease process in MAC and its treatment options.
{"title":"Mitral Annular Calcification: Understanding the Disease and Treatment Options","authors":"Marina Urena MD, PhD , John Kikoïne MD , Mayra Guerrero MD","doi":"10.1016/j.shj.2025.100668","DOIUrl":"10.1016/j.shj.2025.100668","url":null,"abstract":"<div><div>Mitral annular calcification (MAC) is a degenerative process that causes calcium deposits along the mitral annulus. The pathophysiological mechanisms contributing to the development of MAC are not fully understood. The main risk factors for MAC are advanced age, female gender, chronic kidney disease, and conditions predisposing to left ventricular hypertrophy, which increases mitral annulus tension and subsequent annular degeneration. The prevalence of MAC varies widely among studies, from 5% to 42%, depending on the characteristics of the study population and the imaging modality used to make the diagnosis, and it is increasing over time. MAC is independently associated with all-cause mortality, cardiovascular mortality, and the occurrence of cardiovascular disease such as atrial fibrillation, conduction abnormalities, or stroke. MAC can progress and involve the mitral valve leaflets, causing mitral stenosis, mitral regurgitation, or both. Patients who develop symptomatic mitral valve dysfunction associated with significant MAC have lower survival when mitral valve intervention is not performed. However, the surgical risk of these patients is often high, precluding surgery in many. Therefore, transcatheter mitral valve implantation is emerging as an alternative in patients with severe MAC and associated symptomatic mitral valve dysfunction. This manuscript summarizes a description of the disease process in MAC and its treatment options.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100668"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Secondary mitral regurgitation (SMR), classified as ventricular or atrial SMR, is associated with excess mortality, heart failure (HF) hospitalization, and worsening quality of life. Therapy is directed toward the underlying cardiomyopathy first with use of neurohormonal antagonism, cardiac resynchronization therapy and arrhythmia reduction, which can reduce MR severity and improve outcomes, followed by transcatheter therapies. Multimodality imaging in the evaluation of MR is critical to determine the mechanism, severity, and options for intervention. Transcatheter treatment of severe SMR provides a percutaneous option for patients who remain symptomatic despite optimal medical management, and there have been significant advances in the procedural capabilities and devices available for treatment. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure trial demonstrated improvement in morbidity and mortality with use of mitral transcatheter edge-to-edge repair (mTEER). The results of this trial suggest that greater proportionate MR, in which the magnitude of MR is accompanied proportionately with a high degree of LV dilation, confers less clinical benefit. A window of opportunity exists during which time mTEER may improve symptoms and prognosis in HF patients as guided by Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure criteria in stage C HF. This review describes our current understanding of the pathophysiology and treatment of SMR. Additionally, it explores several questions as to the optimal timing of transcatheter intervention, the role of mTEER in moderate MR, our understanding of exercise-induced MR, implications for mitral valvular and ventricular remodeling, and whether mTEER may facilitate optimization of medical therapy.
{"title":"Functional Mitral Regurgitation and the Role of Transcatheter Repair","authors":"Richa Gupta MD, MPH , Holly Gonzales MD , Stacy Tsai MD , Angela Lowenstern MD , JoAnn Lindenfeld MD","doi":"10.1016/j.shj.2024.100347","DOIUrl":"10.1016/j.shj.2024.100347","url":null,"abstract":"<div><div>Secondary mitral regurgitation (SMR), classified as ventricular or atrial SMR, is associated with excess mortality, heart failure (HF) hospitalization, and worsening quality of life. Therapy is directed toward the underlying cardiomyopathy first with use of neurohormonal antagonism, cardiac resynchronization therapy and arrhythmia reduction, which can reduce MR severity and improve outcomes, followed by transcatheter therapies. Multimodality imaging in the evaluation of MR is critical to determine the mechanism, severity, and options for intervention. Transcatheter treatment of severe SMR provides a percutaneous option for patients who remain symptomatic despite optimal medical management, and there have been significant advances in the procedural capabilities and devices available for treatment. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure trial demonstrated improvement in morbidity and mortality with use of mitral transcatheter edge-to-edge repair (mTEER). The results of this trial suggest that greater proportionate MR, in which the magnitude of MR is accompanied proportionately with a high degree of LV dilation, confers less clinical benefit. A window of opportunity exists during which time mTEER may improve symptoms and prognosis in HF patients as guided by Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure criteria in stage C HF. This review describes our current understanding of the pathophysiology and treatment of SMR. Additionally, it explores several questions as to the optimal timing of transcatheter intervention, the role of mTEER in moderate MR, our understanding of exercise-induced MR, implications for mitral valvular and ventricular remodeling, and whether mTEER may facilitate optimization of medical therapy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100347"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.shj.2025.100670
Anita W. Asgar MD
{"title":"The Vital Contribution of Women in Structural Heart Disease — Shaping the Future Through Innovation, Imaging, and Insight","authors":"Anita W. Asgar MD","doi":"10.1016/j.shj.2025.100670","DOIUrl":"10.1016/j.shj.2025.100670","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100670"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.shj.2025.100424
Linda D. Gillam MD, MPH, Philippe Généreux MD
Staging based on extra-valvular cardiac damage is an intuitive approach to categorizing patients with aortic stenosis (AS) that is easily applied using widely available echocardiographic tools. As discussed in this review, it has been shown to be a powerful tool for risk stratification that complements conventional approaches. The original and most widely used framework identifies stage 0 when there is AS without additional cardiac damage; stage 1 when there is left ventricular damage (hypertrophy, systolic or diastolic dysfunction with evidence of elevated filling pressures); stage 2 when there is mitral dysfunction (moderate or greater mitral regurgitation, typically secondary) or left atrial abnormalities (left atrial enlargement or atrial fibrillation); stage 3 when there is pulmonary hypertension and/or moderate or greater tricuspid regurgitation (typically secondary); and stage 4 when there is moderate or greater right ventricular dysfunction. In a series of studies that have collectively evaluated damage before and after aortic valve replacement in patients with moderate and severe AS, as well as with and without symptoms, cardiac damage has been shown to predict all-cause and cardiovascular mortality and other outcomes. These observations support the design of trials to reevaluate thresholds for aortic valve replacement in AS and approaches that consider cardiac damage stage in clinical decision-making for individual patients (valve replacement vs. medical therapy).
{"title":"Staging Aortic Stenosis Based on Cardiac Damage: A New Tool for Risk Prediction, Clinical Decision-Making, and Trial Design","authors":"Linda D. Gillam MD, MPH, Philippe Généreux MD","doi":"10.1016/j.shj.2025.100424","DOIUrl":"10.1016/j.shj.2025.100424","url":null,"abstract":"<div><div>Staging based on extra-valvular cardiac damage is an intuitive approach to categorizing patients with aortic stenosis (AS) that is easily applied using widely available echocardiographic tools. As discussed in this review, it has been shown to be a powerful tool for risk stratification that complements conventional approaches. The original and most widely used framework identifies stage 0 when there is AS without additional cardiac damage; stage 1 when there is left ventricular damage (hypertrophy, systolic or diastolic dysfunction with evidence of elevated filling pressures); stage 2 when there is mitral dysfunction (moderate or greater mitral regurgitation, typically secondary) or left atrial abnormalities (left atrial enlargement or atrial fibrillation); stage 3 when there is pulmonary hypertension and/or moderate or greater tricuspid regurgitation (typically secondary); and stage 4 when there is moderate or greater right ventricular dysfunction. In a series of studies that have collectively evaluated damage before and after aortic valve replacement in patients with moderate and severe AS, as well as with and without symptoms, cardiac damage has been shown to predict all-cause and cardiovascular mortality and other outcomes. These observations support the design of trials to reevaluate thresholds for aortic valve replacement in AS and approaches that consider cardiac damage stage in clinical decision-making for individual patients (valve replacement vs. medical therapy).</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100424"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.shj.2025.100490
Sandra B. Lauck PhD , Connie Clark MSN , Sophie Offen MD, PhD , Erin Tang MSN , Stephanie Sellers PhD
The multidisciplinary heart team (MDT) has been foundational to the rapid advancement of treatment options for valvular heart disease (VHD). Initially designed to guide treatment decisions for patients with aortic stenosis and procedural success of transcatheter aortic valve implantation, the MDT was intended to provide a responsive mechanism to meet the needs of patients and programs. Some of the unintended consequences of guideline endorsement and regulatory requirements have diminished the perceived value and threatened the engagement of team members. To maintain its impact, the VHD MDT must evolve to reflect contemporary priorities. For patients with aortic stenosis, the concept of the MDT must expand to address the significant barriers to timely detection, diagnosis, and referral and leverage its expertise to increase program capacity to accelerate access to care. The comprehensive mitral and tricuspid valve clinical pathway is in its infancy. For this patient group, the membership of the core MDT must be strengthened by the addition of expertise to support imaging diagnostics and procedural guidance, specialty team members who can guide the individualized clinical management of complex VHD, enhanced coordination of care and patient-centered processes, and consideration of unanswered clinical concerns. A recalibrated perspective on the key principles guiding the MDT for clinicians and programs offers opportunities to make the most of lessons learned by promoting quality of care and building a VHD collective and culture that can meet patients’ needs along their journey of care while prioritizing a nimble, tailored, efficient, and high-impact approach.
{"title":"Advancing the Contemporary Multidisciplinary Heart Valve Team: Update on Priorities for Clinicians and Programs","authors":"Sandra B. Lauck PhD , Connie Clark MSN , Sophie Offen MD, PhD , Erin Tang MSN , Stephanie Sellers PhD","doi":"10.1016/j.shj.2025.100490","DOIUrl":"10.1016/j.shj.2025.100490","url":null,"abstract":"<div><div>The multidisciplinary heart team (MDT) has been foundational to the rapid advancement of treatment options for valvular heart disease (VHD). Initially designed to guide treatment decisions for patients with aortic stenosis and procedural success of transcatheter aortic valve implantation, the MDT was intended to provide a responsive mechanism to meet the needs of patients and programs. Some of the unintended consequences of guideline endorsement and regulatory requirements have diminished the perceived value and threatened the engagement of team members. To maintain its impact, the VHD MDT must evolve to reflect contemporary priorities. For patients with aortic stenosis, the concept of the MDT must expand to address the significant barriers to timely detection, diagnosis, and referral and leverage its expertise to increase program capacity to accelerate access to care. The comprehensive mitral and tricuspid valve clinical pathway is in its infancy. For this patient group, the membership of the core MDT must be strengthened by the addition of expertise to support imaging diagnostics and procedural guidance, specialty team members who can guide the individualized clinical management of complex VHD, enhanced coordination of care and patient-centered processes, and consideration of unanswered clinical concerns. A recalibrated perspective on the key principles guiding the MDT for clinicians and programs offers opportunities to make the most of lessons learned by promoting quality of care and building a VHD collective and culture that can meet patients’ needs along their journey of care while prioritizing a nimble, tailored, efficient, and high-impact approach.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100490"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.shj.2025.100667
Dee Dee Wang MD , Pedro A. Villablanca MD , Kent Chak-Yu So MD , Robert J. Cubeddu MD , Brian P. O’Neill MD , William W. O’Neill MD
Physician-led computed tomography (CT) imaging for valvular interventions has directly contributed to the safety and scalability of transcatheter aortic valve interventions globally. As the shift of the global population’s valvular heart disease extends into the transcatheter aortic, mitral, pulmonic, and tricuspid space, CT imaging for valvular interventions in new anatomical pathophysiologies becomes more important than ever. Health systems dedicated to investing in physician-led structural heart imaging CT procedural planning expertise and transcatheter treatment advancements can bring life-saving innovative care to patients in need.
{"title":"CT Imaging for Valvular Interventions","authors":"Dee Dee Wang MD , Pedro A. Villablanca MD , Kent Chak-Yu So MD , Robert J. Cubeddu MD , Brian P. O’Neill MD , William W. O’Neill MD","doi":"10.1016/j.shj.2025.100667","DOIUrl":"10.1016/j.shj.2025.100667","url":null,"abstract":"<div><div>Physician-led computed tomography (CT) imaging for valvular interventions has directly contributed to the safety and scalability of transcatheter aortic valve interventions globally. As the shift of the global population’s valvular heart disease extends into the transcatheter aortic, mitral, pulmonic, and tricuspid space, CT imaging for valvular interventions in new anatomical pathophysiologies becomes more important than ever. Health systems dedicated to investing in physician-led structural heart imaging CT procedural planning expertise and transcatheter treatment advancements can bring life-saving innovative care to patients in need.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100667"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, structural interventions have explored three-dimensional printing and computer simulation technologies to facilitate optimal device selections for more efficient procedures with fewer patient complications. Cardiovascular procedures, both structural interventions and electrophysiological procedures, have examined the utility of intracardiac echocardiography. In this review, we will discuss the growth of these technologies and highlight recent studies with a key focus on left atrial appendage closure.
{"title":"Simulation for Procedural Planning and Intracardiac Echo for Enhancing Precision in Cardiac Interventions With a Focus on Left Atrial Appendage Closure","authors":"Jaya Chandrasekhar MBBS, MS, PhD , Jacqueline Saw MD","doi":"10.1016/j.shj.2025.100671","DOIUrl":"10.1016/j.shj.2025.100671","url":null,"abstract":"<div><div>In recent years, structural interventions have explored three-dimensional printing and computer simulation technologies to facilitate optimal device selections for more efficient procedures with fewer patient complications. Cardiovascular procedures, both structural interventions and electrophysiological procedures, have examined the utility of intracardiac echocardiography. In this review, we will discuss the growth of these technologies and highlight recent studies with a key focus on left atrial appendage closure.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100671"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-30DOI: 10.1016/j.shj.2025.100694
Alena Kurlianskaya MD, PhD , Michael L. Chuang MD , Oleg Polonetsky MD, PhD , Olesya Shatova MD , Jason R. Foerst MD , Kendra J. Grubb MD, MHA , Martin B. Leon MD , Ulrich P. Jorde MD , Mark Reisman MD , Daniel Burkhoff MD, PhD , AccuCinch Study Investigators
{"title":"Reverse Remodeling Induced by Transcatheter Left Ventricular Restoration System Is Sustained Through 2 Years of Follow-Up","authors":"Alena Kurlianskaya MD, PhD , Michael L. Chuang MD , Oleg Polonetsky MD, PhD , Olesya Shatova MD , Jason R. Foerst MD , Kendra J. Grubb MD, MHA , Martin B. Leon MD , Ulrich P. Jorde MD , Mark Reisman MD , Daniel Burkhoff MD, PhD , AccuCinch Study Investigators","doi":"10.1016/j.shj.2025.100694","DOIUrl":"10.1016/j.shj.2025.100694","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100694"},"PeriodicalIF":2.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.
Methods
We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.
Results
At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, p = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, p = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, p = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.
Conclusions
Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.
背景：小叶血栓形成和经导管心脏瓣膜功能障碍是经导管主动脉瓣置换术（TAVR）后的关键问题。延长新窦冲洗时间（NWT）可能使患者易发生小叶减薄增厚（HALT）和小叶血栓形成，增加瓣膜退变的风险。本研究评估了tavr术后30天和1年，计算机视觉主动脉造影显示的体内NWT与血流动力学结果之间的关系。方法回顾性分析2016年至2020年期间接受球囊扩张瓣膜TAVR的2254例患者（平均年龄79±9岁，女性40%）。根据患者的NWTs分为T1组（1.444 ~ 1.870 s, n = 752）、T2组（1.870 ~ 1.939 s, n = 752）和T3组（1.939 ~ 2.110 s, n = 751）。结果30 d时，T3组经瓣主动脉瓣平均梯度高于T1组（12.61±5.07 mmHg vs. 11.98±4.75 mmHg, p = 0.03）。在多变量模型中，与T1相比，T3与主动脉瓣平均梯度增加显著相关（估计：0.703,p = 0.02）。30天时，HALT患者的NWT更高（1.970±0.047 s vs 1.889±0.100 s, p = 0.001）， NWT每增加0.1秒，发生HALT的几率增加三倍。结论延长的NWT与较高的经瓣梯度相关，独立预测tavr后HALT。NWT可以作为一种新的标志物来识别有瓣膜功能障碍风险的患者，并指导早期药物治疗。
{"title":"Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes","authors":"Shivabalan Kathavarayan Ramu MD , Toshiaki Isogai MD, MPH , Saksham Beotra MS , Vishwum Kapadia , Nikita Thakore , Ankit Agrawal MD , Shashank Shekhar MD , Maryam Muhammad Ali Majeed-Saidan MD , Rohan Prasad MD , Agam Bansal MD , Abdelrahman Abushouk MD , Odette Iskandar MD , Larisa G. Tereshchenko MD, PhD , Grant Reed MD , Rishi Puri MD, PhD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Zoran Popovic MD , Amar Krishnaswamy MD , Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100686","DOIUrl":"10.1016/j.shj.2025.100686","url":null,"abstract":"<div><h3>Background</h3><div>Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.</div></div><div><h3>Results</h3><div>At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, <em>p</em> = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, <em>p</em> = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, <em>p</em> = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.</div></div><div><h3>Conclusions</h3><div>Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100686"},"PeriodicalIF":2.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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