Costa Giulia, Angelillis Marco, Giannini Cristina, Mazzola Matteo, Primerano Chiara, Brandi Giulia, Spontoni Paolo, Stazzoni Laura, Petronio Anna Sonia, De Carlo Marco
CardiacThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
CardioVascular Department, University of Pisa, Pisa, Italy.
Am J Cardiol. 2025 Aug 1;248:1-9. doi: 10.1016/j.amjcard.2025.03.028. Epub 2025 Mar 31.
Currently, permanent pacemaker implantation (PPMI) is the most common complication of transcatheter aortic valve implantation (TAVI). The aim of this analysis is to develop a simple and effective risk prediction model for PPMI within 30 days of TAVI. Data from 370 patients who underwent TAVI with the self-expanding valve between February 2015 and June 2022 at our center were collected in the development cohort (DC). A risk score was developed based on baseline anatomical and electrocardiographic characteristics, including the estimation of aortic calcium load (ACL) using both the Agatston score and calcium volume. A validation cohort (VC) of 234 patients was used to test the score. Seventy-two patients (19.5%) underwent PPMI in DC. Preprocedural right bundle branch block (RBBB), membranous septum length (MSL) <5 mm, and severe ACL were significant predictors of PPMI. The Agatston score showed higher agreement with PPMI compared to calcium volume (K = 0.89; 95% CI 0.84 to 0.93 vs K = 0.71; 95% CI 0.64 to 0.79, respectively). Pre-existing RBBB, MSL, and Agatston score have been combined into a simple score, called RITMO (theoretical range from -1 to 4 points). We applied the score to the VC and find that a high score (>1) had an OR>6 to predict PPMI after TAVI. In patients undergoing TAVI with a self-expanding valve, baseline RBBB, shorter MSL, and higher ACL evaluated using the Agatston method were predictive of 30-day PPMI. In conclusion, the RITMO score represents a simple tool for risk stratification, with implications for procedural planning and patient counseling.
目前，永久性起搏器植入（PPMI）是经导管主动脉瓣植入术（TAVI）最常见的并发症。本分析的目的是建立一个简单有效的TAVI术后30天内PPMI风险预测模型。在我们中心，2015年2月至2022年6月期间接受自膨胀瓣膜TAVI的370例患者的数据被纳入开发队列（DC）。基于基线解剖和心电图特征开发了一个风险评分，包括使用阿加斯顿评分和钙体积估计主动脉钙化负荷（ACL）。使用234例患者的验证队列（VC）来测试该评分。DC中有72例患者（19.5%）接受了PPMI。术前右束支传导阻滞（RBBB）、膜性间隔长度（MSL）<5mm和严重ACL是PPMI的显著预测因素。与钙体积相比，阿加斯顿评分与PPMI的一致性更高（K=0.89；95%CI 0.84至0.93，而K=0.71；95%CI 0.64至0.79）。既往存在的RBBB、MSL和阿加斯顿评分已合并为一个简单评分，称为RITMO（理论范围为-1至4分）。我们将该评分应用于VC，发现高分（>1）的OR>6可预测TAVI术后的PPMI。在接受自膨胀瓣膜TAVI的患者中，基线RBBB、较短的MSL以及使用阿加斯顿方法评估的较高ACL可预测30天PPMI。总之，RITMO评分是一种简单的风险分层工具，对手术规划和患者咨询具有指导意义。
