Carrabba Nazario, Valenti Renato, Migliorini Angela, Marrani Marco, Cantini Giulia, Parodi Guido, Dovellini Emilio Vincenzo, Antoniucci David
Departement of Cardiology, Careggi Hospital, Florence, Italy.
Departement of Cardiology, Careggi Hospital, Florence, Italy.
Am J Cardiol. 2015 Jul 1;116(1):125-31. doi: 10.1016/j.amjcard.2015.03.054. Epub 2015 Apr 8.
Conflicting results have been reported about the prognostic impact of left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the impact of LBBB after TAVI on left ventricular (LV) function and remodeling and on 1-year outcomes. Of 101 TAVI patients, 9 were excluded. All complications were evaluated according to the Valve Academic Research Consortium 2 definition. Of 92 patients, 34 developed LBBB without more advanced myocardial damage or inflammation biomarkers in comparison with patients without LBBB. The only predictor of new LBBB was larger baseline LV end-diastolic volume. LBBB plus advanced atrioventricular block was strongly correlated with permanent pacemaker implantation (p <0.0001). Patients with LBBB had a higher rate of permanent pacemaker implantation at 30 days (59% vs 19%, p <0.0001) and less recovery of LV systolic function and a trend toward a lower rate of LV reverse remodeling at 1 year. The development of acute kidney injury and the logistic European System for Cardiac Operative Risk Evaluation score were associated with poor outcomes (all-cause mortality and heart failure) (hazard ratio 6.86, 95% confidence interval 2.51 to 18.74, p <0.0001, and hazard ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.021, respectively), but not LBBB. In conclusion, after TAVI, 37% of patients developed new LBBB without more advanced myocardial damage or inflammation biomarkers. LBBB was associated with a higher rate of permanent pacemaker implantation, which negatively affected the recovery of LV systolic function. The development of acute kidney injury, rather than LBBB, increases the 1-year risk for mortality and hospitalization for heart failure.
关于经导管主动脉瓣植入术（TAVI）后左束支传导阻滞（LBBB）的预后影响，已有相互矛盾的研究结果报道。本研究的目的是评估TAVI后LBBB对左心室（LV）功能、重构以及1年预后的影响。在101例TAVI患者中，9例被排除。所有并发症均根据瓣膜学术研究联盟2的定义进行评估。在92例患者中，34例发生LBBB，与未发生LBBB的患者相比，其心肌损伤或炎症生物标志物并无更严重进展。新发生LBBB的唯一预测因素是基线左心室舒张末期容积较大。LBBB合并高度房室传导阻滞与永久起搏器植入密切相关（p<0.0001）。发生LBBB的患者在30天时永久起搏器植入率更高（59%对19%，p<0.0001），左心室收缩功能恢复较差，且在1年时左心室逆向重构率有降低趋势。急性肾损伤的发生以及欧洲心脏手术风险评估逻辑评分与不良预后（全因死亡率和心力衰竭）相关（风险比6.86，95%置信区间2.51至18.74，p<0.0001；风险比1.04，95%置信区间1.01至1.08，p=0.021），但与LBBB无关。总之，TAVI后，37%的患者出现新的LBBB，且心肌损伤或炎症生物标志物并无更严重进展。LBBB与更高的永久起搏器植入率相关，这对左心室收缩功能的恢复产生负面影响。急性肾损伤的发生而非LBBB增加了1年时死亡和因心力衰竭住院的风险。
