Bioprosthetic Valve Thrombosis Versus Structural Failure: Clinical and Echocardiographic Predictors

Alexander Egbe, Sorin V. Pislaru, Patricia Pellikka, Joseph T. Poterucha, Hartzell V Schaff, Joseph Maleszewski, Heidi M. Connolly

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

BACKGROUND: Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis.

OBJECTIVES: This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT.

METHODS: Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic.

RESULTS: Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p <0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p <0.001).

CONCLUSIONS: BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.

Original languageEnglish (US)
Pages (from-to)2285-2294
Number of pages10
JournalJournal of the American College of Cardiology
Volume66
Issue number21
DOIs
StatePublished - Dec 1 2015

Fingerprint

Thrombosis
Odds Ratio
Bioprosthesis
International Normalized Ratio
Vitamin K
ROC Curve
Atrial Fibrillation
Prostheses and Implants
Linear Models
Logistic Models
Databases
Pathology
Sensitivity and Specificity
Lung

Keywords

  • atrial fibrillation
  • cusp
  • Doppler gradient
  • valvular heart disease
  • vitamin K antagonist

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bioprosthetic Valve Thrombosis Versus Structural Failure : Clinical and Echocardiographic Predictors. / Egbe, Alexander; Pislaru, Sorin V.; Pellikka, Patricia; Poterucha, Joseph T.; Schaff, Hartzell V; Maleszewski, Joseph; Connolly, Heidi M.

In: Journal of the American College of Cardiology, Vol. 66, No. 21, 01.12.2015, p. 2285-2294.

Research output: Contribution to journalArticle

@article{5ea1451d96a247e2a447ada6cdee8c35,
title = "Bioprosthetic Valve Thrombosis Versus Structural Failure: Clinical and Echocardiographic Predictors",
abstract = "BACKGROUND: Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis.OBJECTIVES: This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT.METHODS: Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic.RESULTS: Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6{\%}; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68{\%} were male. Thirty (65{\%}) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p <0.001). Independent predictors of BPVT were >50{\%} increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76{\%} sensitivity, 93{\%} specificity, 85{\%} positive predictive value, and 89{\%} negative predictive value (p <0.001).CONCLUSIONS: BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.",
keywords = "atrial fibrillation, cusp, Doppler gradient, valvular heart disease, vitamin K antagonist",
author = "Alexander Egbe and Pislaru, {Sorin V.} and Patricia Pellikka and Poterucha, {Joseph T.} and Schaff, {Hartzell V} and Joseph Maleszewski and Connolly, {Heidi M.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.jacc.2015.09.022",
language = "English (US)",
volume = "66",
pages = "2285--2294",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "21",

}

TY - JOUR

T1 - Bioprosthetic Valve Thrombosis Versus Structural Failure

T2 - Clinical and Echocardiographic Predictors

AU - Egbe, Alexander

AU - Pislaru, Sorin V.

AU - Pellikka, Patricia

AU - Poterucha, Joseph T.

AU - Schaff, Hartzell V

AU - Maleszewski, Joseph

AU - Connolly, Heidi M.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - BACKGROUND: Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis.OBJECTIVES: This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT.METHODS: Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic.RESULTS: Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p <0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p <0.001).CONCLUSIONS: BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.

AB - BACKGROUND: Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis.OBJECTIVES: This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT.METHODS: Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic.RESULTS: Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p <0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p <0.001).CONCLUSIONS: BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.

KW - atrial fibrillation

KW - cusp

KW - Doppler gradient

KW - valvular heart disease

KW - vitamin K antagonist

UR - http://www.scopus.com/inward/record.url?scp=84951116358&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951116358&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2015.09.022

DO - 10.1016/j.jacc.2015.09.022

M3 - Article

C2 - 26610876

AN - SCOPUS:84951116358

VL - 66

SP - 2285

EP - 2294

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 21

ER -