经导管主动脉瓣置换术后心电图左心室不同步患者的结局
Outcomes in patients with electrocardiographic left ventricular dyssynchrony following transcatheter aortic valve replacement.
作者信息
Ananwattanasuk Teetouch, Atreya Auras R, Teerawongsakul Padoemwut, Ghannam Michael, Lathkar-Pradhan Sangeeta, Latchamsetty Rakesh, Jame Sina, Patel Himanshu J, Grossman Paul Michael, Oral Hakan, Jongnarangsin Krit
机构信息
Division of Cardiac Electrophysiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Cardiology Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand.
Institute of Cardiac Sciences and Research, AIG Hospitals, Gachibowli, Hyderabad, India.
出版信息
Heart Rhythm. 2023 Jan;20(1):22-28. doi: 10.1016/j.hrthm.2022.08.001. Epub 2022 Aug 7.
BACKGROUND
Left bundle branch block (LBBB) and atrioventricular (AV) conduction abnormalities requiring permanent pacemaker (PPM) implantation occur frequently following transcatheter aortic valve replacement (TAVR). The resultant left ventricular (LV) dyssynchrony may be associated with adverse clinical events.
OBJECTIVES
The purpose of this study was to assess the adverse outcomes associated with LV dyssynchrony due to high-burden right ventricular (RV) pacing or permanent LBBB following TAVR in patients with preserved left ventricular ejection fraction (LVEF).
METHODS
Consecutive TAVR patients at the University of Michigan from January 2012 to June 2017 were included. Pre-existing cardiac implantable electronic device, previous LBBB, LVEF <50%, or follow-up period <1 year were excluded. The primary outcome was all-cause mortality. Secondary outcomes included cardiomyopathy (defined as LVEF ≤45%), a composite endpoint of cardiomyopathy or all-cause mortality, and the change in LVEF at 1-year follow-up.
RESULTS
A total of 362 patients were analyzed (mean age 77 years). LV dyssynchrony group (n = 91 [25.1%]) included 56 permanent LBBB patients, 12 permanent LBBB patients with PPM, and 23 non-LBBB patients with PPM and high-burden RV pacing. Remaining patients served as control (n = 271 [74.9%]). After adjusted analysis, LV dyssynchrony had significantly higher all-cause mortality (adjusted hazard ratio [HR] 2.16; 95% confidence interval [CI] 1.07-4.37) and cardiomyopathy (adjusted HR 14.80; 95% CI 6.31-14.69). The LV dyssynchrony group had mean LVEF decline of 10.5% ± 10.2% compared to a small increase (0.5% ± 7.7%) in control.
CONCLUSION
Among TAVR patients with preserved LVEF and normal AV conduction, development of postprocedural LV dyssynchrony secondary to high-burden RV pacing or permanent LBBB was associated with significantly higher risk of death and cardiomyopathy at 1-year follow-up.
背景
经导管主动脉瓣置换术（TAVR）后，需要植入永久起搏器（PPM）的左束支传导阻滞（LBBB）和房室（AV）传导异常频繁发生。由此产生的左心室（LV）不同步可能与不良临床事件相关。
目的
本研究旨在评估左心室射血分数（LVEF）保留的患者TAVR后因高负荷右心室（RV）起搏或永久性LBBB导致的LV不同步相关的不良结局。
方法
纳入2012年1月至2017年6月在密歇根大学连续接受TAVR的患者。排除既往有心脏植入式电子设备、既往LBBB、LVEF<50%或随访期<1年的患者。主要结局是全因死亡率。次要结局包括心肌病（定义为LVEF≤45%）、心肌病或全因死亡率的复合终点以及1年随访时LVEF的变化。
结果
共分析了362例患者（平均年龄77岁）。LV不同步组（n = 91 [25.1%]）包括56例永久性LBBB患者、12例植入PPM的永久性LBBB患者和23例非LBBB且有高负荷RV起搏的PPM患者。其余患者作为对照组（n = 271 [74.9%]）。经过调整分析，LV不同步组的全因死亡率显著更高（调整后风险比[HR] 2.16；95%置信区间[CI] 1.07-4.37），心肌病发生率也显著更高（调整后HR 14.80；95% CI 6.31-14.69）。LV不同步组的平均LVEF下降了10.5%±10.2%，而对照组有小幅上升（0.5%±7.7%）。
结论
在LVEF保留且房室传导正常的TAVR患者中，术后因高负荷RV起搏或永久性LBBB导致的LV不同步与1年随访时显著更高的死亡风险和心肌病风险相关。
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