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首页> 外文期刊>The American Journal of Cardiology >Relation of Left Ventricular Fractional Shortening to Needfor Permanent Pacemaker After Transcatheter AorticValve Implantation
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Relation of Left Ventricular Fractional Shortening to Needfor Permanent Pacemaker After Transcatheter AorticValve Implantation

机译：经截觉管主动脉植入后永久性起搏器需求的左心室分数缩短的关系

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摘要

Transcatheter aortic valve implantation (TAVI) can potentially alter conduction system function due to the mechanical force applied to the conduction system by the proximal edge of the valve, particularly the CoreValve. Some reasons for post-TAVI advanced atrioventricular block have been identified. We investigated whether the degree of the motion of the basal left ventricular (LV) walls impacted the development of advanced atrioventricular block post-TAVI. A total of 407 patients (82.1 ± 6.2 years) without prior permanent pacemakers (PPMs) underwent TAVI using CoreValve (70%) or Edwards-SAPIEN (30%) prosthetic devices. The LV fractional shortening (FS) of the basal segments was measured in each patient, and the association between FS and PPM requirement, or new-onset left bundle branch block (LBBB) was evaluated. During hospitalization, 64 patients (15.7%) required PPM implantation, and 128 patients (31.4%) required PPM implantation or developed new LBBB. Independent predictors of PPM implantation included preprocedural right bundle branch block, CoreValve prosthetic device, valve implantation depth, and FS. Patients with high FS (≥40%, upper tertile) had a 2.5-fold increased risk of PPM implantation (p?=?0.004) and a 1.8-fold increased risk of PPM or new LBBB (p?=?0.020). Every 10% increment in FS was consistently associated with an adjusted 42% increased risk of PPM implantation (p?=?0.015) and with an adjusted 43% increased risk of PPM implantation or new LBBB (p?=?0.005). Thus, in our cohort, LV FS was independently associated with the need for PPM implantation during hospitalization. Hence, this simple echocardiographic measure can be used to identify patients who are at risk after TAVI.
机译：由于阀门的近端边缘，特别是核心瓦尔，电沟管主动脉瓣植入（Tavi）可以潜在地改变导致导电系统功能。已经确定了Tavi先进的房室块的某些原因。我们调查了基底左心室（LV）壁的运动程度是否影响了Tavi后期的房地上块的发育。患者共有407名患者（82.1±6.2岁），没有先前的起搏器（PPMS）使用CoreValve（70％）或Edwards-Sapien（30％）假肢装置进行Tavi。在每位患者中测量基底段的LV分数缩短（FS），评估FS和PPM要求之间的关联或新发起左束分支块（LBBB）。在住院期间，64名患者（15.7％）所需的PPM植入，128名患者（31.4％）所需的PPM植入或开发新的LBBB。 PPM植入的独立预测因子包括预先开发的右束分支块，Corevalve假体装置，阀门注入深度和FS。高FS（≥40％，上部TERTILE）的患者的PPM植入风险增加2.5倍（P？= 0.004），并且PPM或新LBBB的风险增加1.8倍（P？= 0.020）。 FS中的每10％增量始终如一与调整后的42％的PPM植入风险（P？= 0.015），并且调整后的43％增加的PPM植入风险或新的LBB（P？= 0.005）。因此，在我们的队列中，LV FS与住院期间的PPM植入无关。因此，这种简单的超声心动图措施可用于识别Tavi之后存在风险的患者。

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