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Purpose <p>Our hypothesis was that computed tomography angiography (CTA)-derived Hounsfield units (HU) can differentiate between thrombosis and leaflet fibrosis (defined by a lack of response to oral anticoagulation) in patients with bioprosthetic heart valve dysfunction.</p> Materials and methods <p>Valvular leaflet HU were retrospectively assessed in 95 patients (derivation cohort) undergoing CTA 35&#xa0;days after bioprosthetic heart valve (BHV) implantation showing signs of subclinical leaflet thrombosis (hypoattenuated leaflet thickening, HALT). A second (validation) cohort included 46 patients undergoing CTA for suspected BHV dysfunction 2&#xa0;years [interquartile range IQR 1.5–5.0] after valve replacement. This study included CTA between May 2012 and December 2017.</p> Results <p>In the derivation cohort, the median HU (95 patients) was 87 (IQR 77; 96). In the validation cohort, patients with resolution of findings in a follow-up CTA after newly initiated anticoagulation (“thrombosis” subgroup, 19 patients) similarly demonstrated HU of 87 (IQR 74; 100) (<i>p</i> = 0.816). In contrast, patients without improvement under oral anticoagulation (“fibrosis” subgroup, 27 patients) exhibited a median of 137 HU (IQR 116, 164; <i>p</i> &lt; 0.001 vs. thrombosis subgroup). In multivariable Cox regression analysis, lower HU were an independent predictor of thrombosis. C-statistics demonstrated an area under the receiver operating characteristic curve of 0.94 ± 0.02 (CI 0.897–0.983, <i>p</i> &lt; 0.001) with a value of 105 HU resulting in a sensitivity of 84% and a specificity of 91% for the differentiation between thrombosis and fibrosis.</p> Conclusion <p>A value of 105 HU on CTA provides good discriminatory power to distinguish between leaflet fibrosis (as defined by a lack of response to oral anticoagulation) and thrombosis after bioprosthetic valve replacement and may help in choosing optimal treatment.</p> Graphical Abstract <p></p>

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Computed tomography-derived Hounsfield units for the differentiation between thrombosis and leaflet fibrosis in bioprosthetic heart valves

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月5日

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  • Ramona Schmitt,
  • Jonas Hein,
  • Jan Minners,
  • Johannes Brado,
  • Hannah Billig,
  • Manuel Hein,
  • Martin Soschynski,
  • Tobias Krauss,
  • Christopher L. Schlett,
  • Dirk Westermann,
  • Philipp Breitbart,
  • Philipp Ruile

摘要

Purpose

Our hypothesis was that computed tomography angiography (CTA)-derived Hounsfield units (HU) can differentiate between thrombosis and leaflet fibrosis (defined by a lack of response to oral anticoagulation) in patients with bioprosthetic heart valve dysfunction.

Materials and methods

Valvular leaflet HU were retrospectively assessed in 95 patients (derivation cohort) undergoing CTA 35 days after bioprosthetic heart valve (BHV) implantation showing signs of subclinical leaflet thrombosis (hypoattenuated leaflet thickening, HALT). A second (validation) cohort included 46 patients undergoing CTA for suspected BHV dysfunction 2 years [interquartile range IQR 1.5–5.0] after valve replacement. This study included CTA between May 2012 and December 2017.

Results

In the derivation cohort, the median HU (95 patients) was 87 (IQR 77; 96). In the validation cohort, patients with resolution of findings in a follow-up CTA after newly initiated anticoagulation (“thrombosis” subgroup, 19 patients) similarly demonstrated HU of 87 (IQR 74; 100) (p = 0.816). In contrast, patients without improvement under oral anticoagulation (“fibrosis” subgroup, 27 patients) exhibited a median of 137 HU (IQR 116, 164; p < 0.001 vs. thrombosis subgroup). In multivariable Cox regression analysis, lower HU were an independent predictor of thrombosis. C-statistics demonstrated an area under the receiver operating characteristic curve of 0.94 ± 0.02 (CI 0.897–0.983, p < 0.001) with a value of 105 HU resulting in a sensitivity of 84% and a specificity of 91% for the differentiation between thrombosis and fibrosis.

Conclusion

A value of 105 HU on CTA provides good discriminatory power to distinguish between leaflet fibrosis (as defined by a lack of response to oral anticoagulation) and thrombosis after bioprosthetic valve replacement and may help in choosing optimal treatment.

Graphical Abstract