Wearable acoustic cardiography: a novel non-invasive digital sentinel for subclinical leaflet thrombosis after transcatheter aortic valve replacement

A 78-year-old woman with severe aortic stenosis came to medical attention for angina and dyspnoea, which were attributed to severe aortic stenosis. Due to the high surgical risk, a transcatheter aortic valve replacement was performed. Postoperative home monitoring was initiated using a new wearable acoustic cardiography (ACG) device integrated with a dedicated smartphone app (Panel A), which we have started to use for the continuous post-transcatheter aortic valve replacement evaluation of arrhythmias, subclinical leaflet thrombosis (SLT), and cardiac remodelling. While the immediate postoperative spectral analysis during hospitalization was unremarkable, a follow-up ACG spectral analysis at postoperative day 30 revealed a new early systolic, baseless murmur with a peak frequency exceeding 25 Hz (Panel B), highly indicative of SLT. Although transthoracic echocardiography was unremarkable, multidetector computed tomography (MDCT) corroborated the ACG findings, revealing characteristic hypo-attenuated leaflet thickening (HALT) and reduced leaflet motion (Panel C). The patient was, therefore, promptly transitioned from single antiplatelet therapy to anticoagulation with rivaroxaban.