{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T03:33:57Z","timestamp":1769916837240,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Heart Program"},{"name":"Thematic Excellence Programme"},{"DOI":"10.13039\/501100003825","name":"Hungarian Academy of Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003825","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Whether hypoattenuated leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) carries a risk of subclinical brain injury (SBI) is unknown. We investigated whether HALT is associated with SBI detected on magnetic resonance imaging (MRI), and whether post-TAVI SBI impacts the patients\u2019 cognition and outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We prospectively enrolled 153 patients (age: 78.1 \u00b1 6.3 years; female 44%) who underwent TAVI. Brain MRI was performed shortly post-TAVI and 6 months later to assess the occurrence of acute silent cerebral ischaemic lesions (SCIL) and chronic white matter hyperintensities (WMH). HALT was screened by cardiac computed tomography (CT) angiography (CTA) 6 months post-TAVI. Neurocognitive evaluation was performed before, shortly after and 6 months following TAVI. At 6 months, 115 patients had diagnostic CTA and 10 had HALT. HALT status, baseline, and follow-up MRIs were available in 91 cases. At 6 months, new SCIL was evident in 16%, new WMH in 66%. New WMH was more frequent (100 vs. 62%; P = 0.047) with higher median volume (319 vs. 50\u2005mm3; P = 0.039) among HALT-patients. In uni- and multivariate analysis, HALT was associated with new WMH volume (beta: 0.72; 95%CI: 0.2\u20131.39; P = 0.009). The patients\u2019 cognitive trajectory from pre-TAVI to 6 months showed significant association with the 6-month SCIL volume (beta: \u22124.69; 95%CI: \u22129.13 to 0.27; P = 0.038), but was not related to the presence or volume of new WMH. During a 3.1-year follow-up, neither HALT [hazard ratio (HR): 0.86; 95%CI: 0.202\u20133.687; P = 0.84], nor the related WMH burden (HR: 1.09; 95%CI: 0.701\u20131.680; P = 0.71) was related with increased mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>At 6 months post-TAVI, HALT was linked with greater WMH burden, but did not carry an increased risk of cognitive decline or mortality over a 3.1-year follow-up (NCT02826200).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeac191","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T03:48:28Z","timestamp":1664336908000},"page":"1584-1595","source":"Crossref","is-referenced-by-count":12,"title":["Subclinical leaflet thrombosis after transcatheter aortic valve implantation is associated with silent brain injury on brain magnetic resonance imaging"],"prefix":"10.1093","volume":"23","author":[{"given":"Astrid","family":"Apor","sequence":"first","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Bartykowszki","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"},{"name":"MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e1lint","family":"Szilveszter","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"},{"name":"MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Varga","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferenc I","family":"Suhai","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aristomenis","family":"Manouras","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institute , 14186 Stockholm , Sweden"},{"name":"Heart and Vascular Theme, Karolinska University Hospital , 17164 Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-1247","authenticated-orcid":false,"given":"Levente","family":"Moln\u00e1r","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1d\u00e1m L","family":"Jermendy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexisz","family":"Panajotu","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam Franciska","family":"Tur\u00e1ni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical Center \u2013 Hungarian Defense Forces , 1134 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Papp","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-6260","authenticated-orcid":false,"given":"J\u00falia","family":"Kar\u00e1dy","sequence":"additional","affiliation":[{"name":"MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-991X","authenticated-orcid":false,"given":"M\u00e1rton","family":"Kolossv\u00e1ry","sequence":"additional","affiliation":[{"name":"MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00edmea","family":"Kov\u00e1ts","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e1l","family":"Maurovich-Horvat","sequence":"additional","affiliation":[{"name":"MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , 1122 Budapest , Hungary"},{"name":"Medical Imaging Center, Semmelweis University , 1082 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0519-5172","authenticated-orcid":false,"given":"Anik\u00f3 Ilona","family":"Nagy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , 68, V\u00e1rosmajor Street, 1122 Budapest , Hungary"},{"name":"Department of Medicine, Karolinska Institute , 14186 Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,9,28]]},"reference":[{"key":"2022111718423389100_jeac191-B1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jcin.2016.10.042","article-title":"Subclinical leaflet thrombosis in bioprosthetic aortic valves","volume":"10","author":"Sondergaard","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"2022111718423389100_jeac191-B2","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1093\/ejcts\/ezx244","article-title":"Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European association of percutaneous cardiovascular interventions (EAPCI) endorsed by the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS)","volume":"52","author":"Capodanno","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022111718423389100_jeac191-B3","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/S0140-6736(17)30757-2","article-title":"Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study","volume":"389","author":"Chakravarty","year":"2017","journal-title":"Lancet"},{"key":"2022111718423389100_jeac191-B4","doi-asserted-by":"crossref","DOI":"10.1016\/j.jcmg.2016.11.005","article-title":"Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVR","author":"Yanagisawa","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"2022111718423389100_jeac191-B5","doi-asserted-by":"crossref","first-page":"3003","DOI":"10.1016\/j.jacc.2020.04.043","article-title":"Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy","volume":"75","author":"Makkar","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2022111718423389100_jeac191-B6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jcct.2017.11.002","article-title":"Leaflet thrombosis following transcatheter aortic valve implantation","volume":"12","author":"Marwan","year":"2018","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2022111718423389100_jeac191-B7","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1093\/eurheartj\/ehx031","article-title":"Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke","volume":"38","author":"Vollema","year":"2017","journal-title":"Eur Heart J"},{"key":"2022111718423389100_jeac191-B8","doi-asserted-by":"crossref","first-page":"e1748","DOI":"10.4244\/EIJ-D-17-01062","article-title":"Bioprosthetic aortic valve leaflet thrombosis detected by multidetector computed tomography is associated with adverse cerebrovascular events: a meta-analysis of observational studies","volume":"13","author":"Rashid","year":"2018","journal-title":"EuroIntervention"},{"key":"2022111718423389100_jeac191-B9","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.jcin.2018.04.006","article-title":"Medium-term follow-up of early leaflet thrombosis after transcatheter aortic valve replacement","volume":"11","author":"Ruile","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"2022111718423389100_jeac191-B10","doi-asserted-by":"crossref","first-page":"e007349","DOI":"10.1161\/CIRCINTERVENTIONS.118.007349","article-title":"Early and late leaflet thrombosis after transcatheter aortic valve replacement","volume":"12","author":"Yanagisawa","year":"2019","journal-title":"Circ Cardiovasc Interv"},{"key":"2022111718423389100_jeac191-B11","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1056\/NEJMoa1509233","article-title":"Possible subclinical leaflet thrombosis in bioprosthetic aortic valves","volume":"373","author":"Makkar","year":"2015","journal-title":"N Engl J Med"},{"key":"2022111718423389100_jeac191-B12","first-page":"63","article-title":"Cardiovascular disease and brain health: focus on white matter hyperintensities","volume":"19","author":"Moroni","year":"2018","journal-title":"Int J Cardiol Heart Vasc"},{"key":"2022111718423389100_jeac191-B13","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1038\/nrcardio.2013.162","article-title":"Silent cerebral infarcts associated with cardiac disease and procedures","volume":"10","author":"Hassell","year":"2013","journal-title":"Nat Rev Cardiol"},{"key":"2022111718423389100_jeac191-B14","doi-asserted-by":"crossref","first-page":"e0168852","DOI":"10.1371\/journal.pone.0168852","article-title":"Subacute subclinical brain infarctions after transcatheter aortic valve implantation negatively impact cognitive function in long-term follow-up","volume":"12","author":"Ghanem","year":"2017","journal-title":"PLoS One"},{"key":"2022111718423389100_jeac191-B15","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.jacc.2009.12.026","article-title":"Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging","volume":"55","author":"Ghanem","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2022111718423389100_jeac191-B16","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.jcin.2020.03.004","article-title":"Evolution, predictors, and neurocognitive effects of silent cerebral embolism during transcatheter aortic valve replacement","volume":"13","author":"De Carlo","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2022111718423389100_jeac191-B17","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1093\/eurheartj\/ehab002","article-title":"Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis","volume":"42","author":"Woldendorp","year":"2021","journal-title":"Eur Heart J"},{"key":"2022111718423389100_jeac191-B18","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.amjcard.2020.04.023","article-title":"Meta-analysis of prevalence and risk factors for cognitive decline and improvement after transcatheter aortic valve implantation","volume":"127","author":"Ghezzi","year":"2020","journal-title":"Am J Cardiol"},{"key":"2022111718423389100_jeac191-B19","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/ehjci\/jez256","article-title":"Subclinical leaflet thrombosis is associated with impaired reverse remodelling after transcatheter aortic valve implantation","volume":"21","author":"Szilveszter","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2022111718423389100_jeac191-B20","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1093\/eurheartj\/ehv526","article-title":"Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves","volume":"37","author":"Pache","year":"2016","journal-title":"Eur Heart J"},{"key":"2022111718423389100_jeac191-B21","doi-asserted-by":"crossref","first-page":"3774","DOI":"10.1016\/j.neuroimage.2011.11.032","article-title":"An automated tool for detection of FLAIR-hyperintense white-matter lesions in multiple sclerosis","volume":"59","author":"Schmidt","year":"2012","journal-title":"Neuroimage"},{"key":"2022111718423389100_jeac191-B22","doi-asserted-by":"crossref","first-page":"3461","DOI":"10.1161\/STROKEAHA.114.005919","article-title":"Emerging spectra of silent brain infarction","volume":"45","author":"Fanning","year":"2014","journal-title":"Stroke"},{"key":"2022111718423389100_jeac191-B23","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1212\/01.wnl.0000434309.85312.19","article-title":"A brief cognitive test battery to differentiate Alzheimer\u2019s disease and frontotemporal dementia","volume":"55","author":"Mathuranath","year":"2000","journal-title":"Neurology"},{"key":"2022111718423389100_jeac191-B24","article-title":"ESC\/EACTS guidelines for the management of valvular heart disease","author":"Vahanian","year":"2021","journal-title":"Eur Heart J"},{"key":"2022111718423389100_jeac191-B25","doi-asserted-by":"crossref","first-page":"e011480","DOI":"10.1161\/CIRCINTERVENTIONS.121.011480","article-title":"Clinical impact of hypoattenuating leaflet thickening after transcatheter aortic valve replacement","volume":"15","author":"Garcia","year":"2022","journal-title":"Circ Cardiovasc Interv"},{"key":"2022111718423389100_jeac191-B26","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1093\/ejcts\/ezz099","article-title":"Incidence, predictors and cerebrovascular consequences of leaflet thrombosis after transcatheter aortic valve implantation: a systematic review and meta-analysis","volume":"56","author":"D\u2019Ascenzo","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022111718423389100_jeac191-B27","article-title":"Subclinical leaflet thrombosis after transcatheter aortic valve replacement: a meaningless finding? A systematic review and meta-analysis","author":"Casula","year":"2020","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2022111718423389100_jeac191-B28","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.amjcard.2020.07.018","article-title":"Meta-analysis of incidence, predictors and consequences of clinical and subclinical bioprosthetic leaflet thrombosis after transcatheter aortic valve implantation","volume":"132","author":"Sannino","year":"2020","journal-title":"Am J Cardiol"},{"key":"2022111718423389100_jeac191-B29","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jstrokecerebrovasdis.2010.09.004","article-title":"Silent cerebral infarcts and cerebral white matter lesions in patients with nonvalvular atrial fibrillation","volume":"21","author":"Kobayashi","year":"2012","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2022111718423389100_jeac191-B30","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1212\/WNL.0b013e3181ad53fd","article-title":"Cognitive impairment risk: white matter hyperintensity progression matters","volume":"73","author":"Silbert","year":"2009","journal-title":"Neurology"},{"key":"2022111718423389100_jeac191-B31","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1080\/24748706.2020.1805534","article-title":"Subclinical leaflet thrombosis post transcatheter aortic valve replacement\u2014an update for 2020","volume":"4","author":"Brown","year":"2020","journal-title":"Struct Heart"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/23\/12\/1584\/47105113\/jeac191.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/23\/12\/1584\/47105113\/jeac191.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T18:43:07Z","timestamp":1668710587000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/23\/12\/1584\/6724473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,28]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,9,28]]},"published-print":{"date-parts":[[2022,11,17]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeac191","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12,1]]},"published":{"date-parts":[[2022,9,28]]}}}