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Hypo-attenuated leaflet thickening (HALT)\u2014a marker of subclinical leaflet thrombosis commonly detected by cardiac computed tomography (CT) after TAVI\u2014may influence valve durability and function. The purpose of this study was to compare commissural alignment of the native and prosthetic aortic valves in cardiac CT in subjects with and without HALT and thereby identify commissural misalignment as potential predictor for leaflet thrombosis after TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In 170 subjects, 85 with and 85 without HALT in post-TAVI CT, commissural orientation of the prosthesis was determined comparing native and prosthetic aortic valve orientation in cardiac CT by measuring the commissural angle relative to the right coronary ostium in the aortic valve plane. For the prosthetic valve, any deviation\u2009\u2264\u200915\u00b0 compared to the native valve was classified as \u201caligned\u201d; 16\u201330\u00b0 as \u201cmild\u201d, 31\u201345\u00b0 as \u201cmoderate\u201d and\u2009\u2265\u200945\u00b0 as \u201csevere\u201d misalignment.<\/jats:p>\n                    <jats:p>\n                      Among subjects with HALT, median angular deviation was higher (36\u00b0, IQR 31\u00b0) than in the control group (29\u00b0, IQR 29\u00b0,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.042). \u201cSevere\u201d misalignment was more frequent in subjects who developed HALT (\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      31, 37%) compared to the control group (\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      17, 20%,\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.013). In logistic regression analysis, more severe deviation (\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.015, OR\u2009=\u20091.02 per 1\u00b0 deviation) and \u201csevere\u201d misalignment (\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.018, OR\u2009=\u20092.2) represented independent predictors for the occurrence of HALT after TAVI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Subclinical leaflet thrombosis after TAVI is associated with commissural misalignment. Potential clinical advantages of obtaining commissural alignment remain to be systematically assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                    <jats:p>\n                      Association of HALT with commissural misalignment after TAVI.\n                      <jats:italic>HALT<\/jats:italic>\n                      hypo-attenuated leaflet thickening,\n                      <jats:italic>IQR<\/jats:italic>\n                      interquartile range,\n                      <jats:italic>TAVI<\/jats:italic>\n                      transfemoral aortic valve replacement\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-023-02192-6","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T08:04:27Z","timestamp":1680768267000},"page":"29-37","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Commissural misalignment independently predicts leaflet thrombosis after transcatheter aortic valve implantation"],"prefix":"10.1007","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4031-6304","authenticated-orcid":false,"given":"Susanne","family":"Jung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Ammon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Smolka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Moshage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Marwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Achenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"issue":"7","key":"2192_CR1","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","volume":"43","author":"A Vahanian","year":"2022","unstructured":"Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al (2022) 2021 ESC\/EACTS Guidelines for the management of valvular heart disease. 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There is a consulting agreement with Edwards Lifescience.\u00a0All the other authors report that they have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}