Barbe Thomas, Fauvel Charles, Hemery Thibaut, Le Pessec Guillaume, Tron Christophe, Bouhzam Najime, Bettinger Nicolas, Burdeau Julie, Makke Jade, Laissac Quentin, Dacher Jean-Nicolas, Eltchaninoff Helene, Durand Eric
Department of Cardiology, Inserm U1096, Univ Rouen Normandie, CHU Rouen, Rouen, France.
Department of Radiology, Univ Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France.
Open Heart. 2025 Jan 11;12(1):e002934. doi: 10.1136/openhrt-2024-002934.
Conductive disturbances requiring permanent pacemaker (PPM) implantation remain a major concern after transcatheter aortic valve implantation (TAVI).
To assess the impact of aortic valve calcium score (AVCS) on conductive disturbances requiring PPM after TAVI.
All patients who underwent TAVI with accessible AVCS from the preprocedural CT scan report were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disturbance requiring PPM at 30 days. The association between PPM and AVCS, with its incremental prognostic value, was analysed using multivariable logistic regression, receiver operating characteristic curve analysis and likelihood ratio (LR) test.
We included 761 patients of which 125 (16%) required PPM at 30 days. AVCS score was significantly higher in patients requiring PPM (3788 (2487-5218) vs 3050 (2043-4367) AU, p<0.001). Using multivariable analysis, preprocedural right bundle branch block (RBBB) (OR 6.61, 95% CI 3.82 to 11.5, p<0.001), first atrioventricular block (OR 1.71, 95% CI 1.03 to 2.83, p=0.037), self-expanding valve (OR 3.25, 95% CI 1.17 to 9.09, p=0.025) and AVCS>4510 AU (OR 1.83, 95% CI 1.04 to 3.20, p=0.035) were independently associated with PPM. AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPM risk factors. An algorithm was proposed based on the initial presence of RBBB, AVCS and the type of implanted valve.
Even if RBBB remained the strongest predictor of PPM post-TAVI, this study suggests that a high AVCS may help identifying patients at increased risk of PPM after TAVI, especially among those without pre-existing RBBB.
经导管主动脉瓣植入术（TAVI）后，需要植入永久起搏器（PPM）的传导障碍仍是一个主要问题。
评估主动脉瓣钙化评分（AVCS）对TAVI后需要PPM的传导障碍的影响。
本回顾性单中心研究纳入了所有接受TAVI且术前CT扫描报告中有可获取AVCS的患者。主要终点是30天时发生需要PPM的传导障碍。使用多变量逻辑回归、受试者工作特征曲线分析和似然比（LR）检验分析PPM与AVCS之间的关联及其增量预后价值。
我们纳入了761例患者，其中125例（16%）在30天时需要PPM。需要PPM的患者AVCS评分显著更高（3788（2487 - 5218）对3050（2043 - 4367）AU，p<0.001）。使用多变量分析，术前右束支传导阻滞（RBBB）（比值比6.61，95%置信区间3.82至11.5，p<0.001）、一度房室传导阻滞（比值比1.71，95%置信区间1.03至2.83，p = 0.037）、自膨胀瓣膜（比值比3.25，95%置信区间1.17至9.09，p = 0.025）和AVCS>4510 AU（比值比1.83，95%置信区间1.04至3.20，p = 0.035）与PPM独立相关。AVCS在传统PPM危险因素之外具有增量判别价值（C指数0.79对0.77，LR检验p = 0.036）。基于RBBB的初始存在、AVCS和植入瓣膜类型提出了一种算法。
即使RBBB仍然是TAVI后PPM的最强预测因素，但本研究表明，高AVCS可能有助于识别TAVI后PPM风险增加的患者，尤其是在那些无既往RBBB的患者中。
