Hyde Emily K, Throndson Karen, Arcinas Liane A, Shah Ashish H, Hiebert Brett, Yamashita Michael H, Lee Samson Donna, Maric Anita, Love Reid, Poettcker Denise, Arora Rakesh C, Seifer Colette M, Kass Malek
Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
CJC Open. 2022 Aug 27;4(12):1060-1068. doi: 10.1016/j.cjco.2022.08.010. eCollection 2022 Dec.
Permanent pacemaker (PPM) implantation may be indicated post-transcatheter aortic valve implantation (TAVI). The Emory Risk Score (ERS) is a validated predictive risk score of the need for a PPM post-TAVI using a balloon-expandable valve. Our objectives were to determine the validity of the ERS in our local TAVI population with both balloon-expandable and self-expanding valves and to identify additional electrocardiographic (ECG) parameters predictive of the need for a PPM post-TAVI.
Retrospective chart and electronic database reviews were performed to collect demographic and procedural information. Two expert readers reviewed all ECGs. Independent factors associated with PPM implantation were examined with multivariable logistic regression via a stepwise selection process with calculation of the area under the receiver operating characteristic curve to assess model discrimination.
The overall PPM implantation rate was 11.7%; rates were 9% for the Sapien 3 valves, 10% for the Evolut Pro valves, and 17% for the Evolut R valves. The ERS was found to not be predictive of need for PPM post-TAVI for the entire cohort. Right bundle branch block was the only ERS parameter independently associated with new PPM implant (8.5% vs 25%, odds ratio = 3.59, = 0.01). No additional ECG parameters met the criteria for statistical significance.
The poor predictive value of the ERS in determining the need for a PPM post-TAVI in our patient population suggests that further refinement of a formula (or risk-calculator) is warranted. Identification of a precise risk-calculator is likely to facilitate patient mobilization and reduce inpatient healthcare resource utilization.
经导管主动脉瓣植入术（TAVI）后可能需要植入永久性起搏器（PPM）。埃默里风险评分（ERS）是一种经过验证的预测风险评分，用于预测使用球囊扩张瓣膜进行TAVI后是否需要植入PPM。我们的目标是确定ERS在我们当地使用球囊扩张瓣膜和自膨胀瓣膜的TAVI人群中的有效性，并确定其他预测TAVI后需要植入PPM的心电图（ECG）参数。
进行回顾性病历和电子数据库审查以收集人口统计学和手术信息。两位专家读者审查了所有心电图。通过逐步选择过程，采用多变量逻辑回归分析与PPM植入相关的独立因素，并计算受试者工作特征曲线下面积以评估模型的辨别力。
总体PPM植入率为11.7%；Sapien 3瓣膜的植入率为9%，Evolut Pro瓣膜为10%，Evolut R瓣膜为17%。发现ERS不能预测整个队列中TAVI后是否需要PPM。右束支传导阻滞是与新的PPM植入独立相关的唯一ERS参数（8.5%对25%，比值比=3.59，P=0.01）。没有其他ECG参数达到统计学意义标准。
ERS在确定我们患者群体中TAVI后是否需要PPM方面预测价值不佳，这表明有必要进一步完善公式（或风险计算器）。确定精确的风险计算器可能有助于患者活动，并减少住院医疗资源的利用。
