Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Am J Cardiol. 2022 Jul 15;175:80-87. doi: 10.1016/j.amjcard.2022.03.053. Epub 2022 May 18.
Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated. This is an international, multicenter, retrospective study of patients who underwent TAVI from July 31, 2007, to May 8, 2020. A total of 2,240 patients were included, and 17.5% of patients developed NOP-LBBB. NOP-LBBB was associated with cardiac mortality (adjusted hazard ratio [aHR] 1.419, 95% confidence interval [CI] 1.014 to 1.985, p = 0.041) and the composite outcomes of cardiac mortality and/or heart failure readmission (aHR 1.313, 95% CI 1.027 to 1.678, p = 0.030). Patients who developed NOP-LBBB with pre-TAVI left ventricular ejection fraction (LVEF) <40% were significantly associated with cardiac mortality (aHR 2.049, 95% CI 1.039 to 4.041, p = 0.038), heart failure (aHR 3.990, 95% CI 2.362 to 6.741, p <0.001), and the composite outcome (aHR 2.729, 95% CI 1.703 to 4.374, p <0.001). Although NOP-LBBB with pre-TAVI LVEF >40% had a significant decrease in LVEF 6 to 12 months after TAVI (-1.8 ± 9.7% vs +0.6 ± 8.1%, p = 0.003), NOP-LBBB with pre-TAVI LVEF <40% had a significant increase in LVEF 6 to 12 months after TAVI (+9.7 ± 13.6% vs +13.0 ± 11.7%, p = 0.157). In conclusion, patients with NOP-LBBB without pre-TAVI and post-TAVI PPM developed significantly worse long-term outcomes, especially in patients with pre-TAVI LVEF <40%. Further prospective investigation should be undertaken.
先前的研究报告称，新发持续性左束支传导阻滞（NOP-LBBB）与经导管主动脉瓣置换术（TAVI）后的预后较差有关。然而，这些结果可能因 TAVI 前后永久性起搏器（PPM）植入的存在而受到影响。NOP-LBBB 患者 TAVI 前后未植入 PPM 的长期预后和风险分层尚未得到充分研究。这是一项国际多中心回顾性研究，纳入了 2007 年 7 月 31 日至 2020 年 5 月 8 日期间接受 TAVI 的患者。共纳入 2240 例患者，其中 17.5%的患者发生了 NOP-LBBB。NOP-LBBB 与心脏死亡率相关（校正后危险比[aHR]1.419，95%置信区间[CI]1.014 至 1.985，p=0.041）和心脏死亡率和/或心力衰竭再入院的复合结局（aHR 1.313，95%CI 1.027 至 1.678，p=0.030）。TAVI 前左心室射血分数（LVEF）<40%且发生 NOP-LBBB 的患者与心脏死亡率显著相关（aHR 2.049，95%CI 1.039 至 4.041，p=0.038）、心力衰竭（aHR 3.990，95%CI 2.362 至 6.741，p<0.001）和复合结局（aHR 2.729，95%CI 1.703 至 4.374，p<0.001）。尽管 TAVI 前 LVEF>40%的 NOP-LBBB 在 TAVI 后 6 至 12 个月时 LVEF 显著下降（-1.8±9.7%比+0.6±8.1%，p=0.003），但 TAVI 前 LVEF<40%的 NOP-LBBB 在 TAVI 后 6 至 12 个月时 LVEF 显著增加（+9.7±13.6%比+13.0±11.7%，p=0.157）。总之，TAVI 前和 TAVI 后无 PPM 的 NOP-LBBB 患者的长期预后明显较差，尤其是 TAVI 前 LVEF<40%的患者。应进行进一步的前瞻性研究。
