Aortic Annulus to Left Coronary Distance as a Predictor for Persistent Left Bundle Branch Block After TAVI

作者：Hein Rothweiler Ralph; Jochheim David; Rizas Konstantinos; Egger Alexander; Theiss Hans; Bauer Axel; Mas**erg Steffen; Mehilli Julinda

来源：Catheterization and Cardiovascular Interventions, 2017, 89(4): E162-E168.

DOI：10.1002/ccd.26503

• aortic valve disease
• percutaneous intervention
• risk stratification
• imaging
• electron beam CT/multidetector CT
• statistical analysis

Objectives: To identify potential predictors for ventricular conduction delay and to evaluate the impact of interventricular dyssynchrony on mortality after implantation of a balloon-expandable aortic valve (BEV). Methods and results: Clinical, computertomo-graphical (CT), and electrocardiographical (ECG) data from 225 transcatheter aortic valve implantation (TAVI) patients were analyzed. Procedures were performed between May 2010 and September 2013 via transfemoral access using a BEV. Incidence of new-onset left bundle branch block (NOP-LBBB) at discharge was 23.1% (n552). Predictive factors for NOP-LBBB were first degree atrioventricular (AV) block (odds ratio (OR): 3.91, 95% confidence interval (CI): 1.58 to 9.64), area cover index (OR: 1.83, 95% CI: 1.26 to 2.67), annulus calcification >first degree (OR: 3.01, 95% CI: 1.36 to 6.66), and annulus to left coronary distance (OR: 0.65, 95% CI: 0.44 to 0.96). At 1-year follow-up, no significant difference was observed concerning all-cause mortality (15.6% among non NOP-LBBB and 9.6% among NOP-LBBB patients, P = 0.278) and cardiovascular mortality (4.6% among non NOP-LBBB and 5.8% among NOP-LBBB patients, P = 0.737). Conclusion: In addition to previous predictors, annulus to left coronary distance and area cover index have been identified as new predictors for NOP-LBBB. NOP-LBBB showed no relevant impact on mortality after one year. Further investigation including larger populations and longer follow-up is required to confirm these findings and develop an algorithm for identification of patients at risk for NOP-LBBB associated adverse events.

• 出版日期2017-3-1