NEW research suggests wearable acoustic cardiography (ACG) technology may provide an effective non-invasive method for diagnosing subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement (TAVR).
SLT is a frequent complication of TAVR, traditionally diagnosed using multidimensional CT (MDCT), which carries risks such as contrast-induced nephropathy. This prospective cohort study investigated the utility of an innovative ACG device as a diagnostic alternative. A total of 116 patients with severe symptomatic aortic stenosis undergoing TAVR were enrolled. Clinical data, including ACG measurements and MDCT imaging, were analysed to evaluate the ability of ACG to detect SLT during follow-up. Patients were categorised into three groups based on SLT severity: no SLT (Group 1), mild SLT (Group 2), and moderate-to-severe SLT (Group 3).
At the 1-month follow-up, MDCT revealed SLT in 25% of patients, with 11.2% exhibiting moderate-to-severe SLT. ACG identified unique acoustic patterns – early systolic, baseless, and high-energy murmurs – in Group 3 patients, distinguishing them from those with milder or no SLT. Diagnostic performance of ACG for moderate-to-severe SLT was high, with sensitivity of 84.62%, specificity of 91.26%, and an AUC of 0.920 (95% CI: 0.855–0.962, p<0.001). At 6 months, nine out of 13 patients with moderate-to-severe SLT showed complete resolution following anticoagulant therapy, confirmed by both ACG and MDCT.
These findings suggest that ACG can effectively diagnose moderate-to-severe SLT post-TAVR by detecting haemodynamic deterioration. Its non-invasive nature, high diagnostic accuracy, and ability to monitor treatment response make it a promising alternative to MDCT, especially in patients at risk for contrast-induced nephropathy. Further research is needed to validate these findings and refine ACG for broader clinical application. Incorporating ACG into standard practice could reduce dependence on MDCT, improve patient safety, and enhance early detection and management of SLT.
Katrina Thornber, EMJ
Reference
Liu R et al. New wearable cardiac acoustic monitoring technology for evaluation of subclinical leaflet thrombosis after transcatheter aortic valve replacement. Heart. 2024;DOI:10.1136/heartjnl-2024-324698.
