Potential role of closure time with adenosine diphosphate in diagnosis of mitral prosthetic paravalvular leak and prognosis after repair

Introduction and objectives: Mitral paravalvular leak (PVL) is associated with hemolysis and heart failure. It has also been linked to shear stress-induced von Willebrand factor abnormalities that prolong closure time with adenosine diphosphate (CT-ADP). The aim of this study was to assess whether C...

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Detalles Bibliográficos
Autores: Belahnech, Yassin|||0000-0003-0723-1023, Martí Aguasca, Gerard, García del Blanco, Bruno|||0000-0002-4527-1600, Ródenas-Alesina, Eduard|||0000-0003-1638-7820, Subirà-Ingla, Arnau, del Fresno, Sergio, Sao-Avilés, Augusto|||0000-0001-8497-0909, Solsona-Caravaca, Javier|||0000-0001-6115-7544, Galian-Gay, Laura|||0000-0001-6828-5928, Fernández-Galera, Rubén|||0000-0002-3870-9360, González-Fernández, Víctor, Bellera Gotarda, Neus|||0000-0002-1040-0900, Serra-García, Vicenc, Otaegui, Imanol|||0000-0001-6594-3139, Serra, Bernat, Calabuig Goena, Alvaro|||0000-0001-8388-4988, Soriano-Colomé, Toni|||0000-0002-2121-6084, Uribarri, Aitor|||0000-0002-6911-7480, Ferreira-Gonzalez, Ignacio|||0000-0002-1208-5561
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::044ecabba42bfe10ad8cc4842e4d350c
Acceso en línea:https://ddd.uab.cat/record/327690
https://dx.doi.org/urn:doi:10.1016/j.rec.2026.02.001
Access Level:acceso embargado
Palabra clave:Mitral paravalvular leak
Closure time with adenosine diphosphate
Paravalvular leak closure
Von Willebrand factor
Biomarkers
Shear stress
Fuga paravalvular mitral
Tiempo de obturación de la adenosina difosfato
Cierre de fuga paravalvular
Factor de von Willebrand
Biomarcadores
Estrés de cizallamiento
Descripción
Sumario:Introduction and objectives: Mitral paravalvular leak (PVL) is associated with hemolysis and heart failure. It has also been linked to shear stress-induced von Willebrand factor abnormalities that prolong closure time with adenosine diphosphate (CT-ADP). The aim of this study was to assess whether CT-ADP serves as a biomarker for mitral PVL diagnosis, follow-up, and prognosis after repair. Methods: In this prospective study, 89 patients (27 with moderate-to-severe mitral PVL referred for closure, group 1; 31 with prosthetic mitral valves without PVL, group 2; and 31 controls without valvular disease, group 3) underwent laboratory assessment including hemolysis markers, congestion markers, and CT-ADP. Patients with PVL underwent percutaneous or surgical repair and were followed up at 3 and 12 months. ROC analysis, linear regression, and Cox models were used to evaluate the diagnostic and prognostic value of CT-ADP. Results: CT-ADP was prolonged in PVL patients (median, 214seconds) vs control groups (86 seconds in group 2 and 74seconds in group 3; P <.001). A cutoff of> 135seconds showed excellent diagnostic accuracy (AUROC, 0.96; sensitivity 89%, specificity 97%). Postprocedural CT-ADP decreased significantly after successful repair (median decrease of 79seconds) but remained unchanged in those with residual leaks. Elevated postprocedural CT-ADP (>155 s) identified persistent PVL and was associated with worse 1-year outcomes (HR, 21.37; P=.004), including death, heart failure or hemolysis-related readmission, and reintervention. Conclusions: CT-ADP appears to be a promising biomarker for diagnosing and monitoring mitral PVL. It may add value to conventional markers by reflecting shear stress-related platelet dysfunction and predicting outcomes following PVL closure.

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