Prognostic Value of QRS Duration After Transcatheter Aortic Valve Implantation for Aortic Stenosis Using the CoreValve

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• 作者：Kentaro Meguro ; MD^a ; ^b ; ^{meguro@med.email.ne.jp} ; Nicolas Lellouche ; MD^a ; Masanori Yamamoto ; MD^a ; Emilie Fougeres ; MD^a ; Jean-Luc Monin ; MD^a ; Pascal Lim ; MD^a ; Gauthier Mouillet ; MD^a ; Jean-Luc Dubois-Rande ; MD^a ; Emmanuel Teiger ; MD^a
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 June, 2013
• 年：2013
• 卷：111
• 期：12
• 页码：1778-1783
• 全文大小：274 K

文摘

Transcatheter aortic valve implantation (TAVI) is effective in treating severe aortic stenosis in high-risk surgical patients. We evaluated the value of the QRS duration (QRSd) in predicting the mid-term morbidity and mortality after TAVI. We conducted a prospective cohort study of 91 consecutive patients who underwent TAVI using the CoreValve at our teaching hospital cardiology unit in 2008 to 2010 who survived to hospital discharge; 57 % were women, and their mean age was 84 ¡À 7 years. The QRSd at discharge was used to classify the patients into 3 groups: QRSd ¡Ü120 ms, n?= 18 (20 % ); QRSd >120 ms but?¡Ü150?ms, n?= 30 (33 % ); and QRSd >150 ms, n?= 43 (47 % ). We used 2 end points: (1) all-cause mortality and (2) all-cause mortality or admission for heart failure. After a median of 12 months, the normal-QRSd patients showed a trend toward, or had, significantly better overall survival and survival free of admission for heart failure compared with the intermediate-QRSd group (p?= 0.084 and p?= 0.002, respectively) and the long-QRSd group (p?= 0.015 and p?= 0.001, respectively). The factors significantly associated with?all-cause mortality were the Society of Thoracic Surgeons score, aortic valve area, post-TAVI dilation, acute kidney injury, hospital days after TAVI, and QRSd at discharge. On multivariate analysis, QRSd was the strongest independent predictor of all-cause mortality (hazard ratio 1.036, 95 % confidence interval 1.016 to 1.056; p <0.001) and all-cause mortality or heart failure admission (hazard ratio 1.025, 95 % confidence interval 1.011 to 1.039; p <0.001). The other independent predictors were the Society of Thoracic Surgeons score, acute kidney injury, and post-TAVI hospital days. In conclusion, a longer QRSd after TAVI was associated with greater morbidity and mortality after 12 months. The QRSd at discharge independently predicted mortality and morbidity after TAVI.