Impact of New-Onset Persistent Left Bundle Branch Block on Reverse Cardiac Remodeling and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Frontiers in Cardiovascular Medicine

Jong-Won Ha¹  Jiwon Seo¹  Young-Guk Ko¹  Jung-Sun Kim¹  Sung-Jin Hong¹  Seung-Jun Lee¹  Geu-Ru Hong¹  Chi Young Shim¹  Byeong-Keuk Kim¹  Yong-Joon Lee¹  Chul-Min Ahn¹  Myeong-Ki Hong¹  JiWung Ryu¹  Iksung Cho¹  Kyu Kim¹  Donghoon Choi² 

[1] Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea;Division of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea;

关键词: transcatheter aortic valve replacement;    left bundle branch block;    cardiac remodeling;    prognosis;    aortic stenosis;   

DOI  :  10.3389/fcvm.2022.893878

来源: DOAJ

【 摘 要 】

BackgroundThe clinical implication of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. We investigated the impact of new-onset persistent LBBB on reverse cardiac remodeling and clinical outcomes after TAVR.MethodsAmong 478 patients who had undergone TAVR for symptomatic severe aortic stenosis from 2011 to 2021, we analyzed 364 patients after excluding patients with pre-existing intraventricular conduction disturbance or a pacing rhythm before or during the indexed hospitalization for TAVR. Echocardiographic variables of cardiac remodeling at baseline and 1 year after TAVR were comprehensively analyzed. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. Secondary outcomes were all-cause death and individual components of the primary outcome.ResultNew-onset persistent LBBB occurred in 41 (11.3%) patients after TAVR. The no LBBB group showed a significant increase in the left ventricular (LV) ejection fraction and decreases in LV dimensions, the left atrial volume index, and LV mass index 1 year after TAVR (all p < 0.001). However, the new LBBB group showed no significant changes in these parameters. During a median follow-up of 18.1 months, the new LBBB group experienced a higher incidence of primary outcomes [hazard ratio (HR): 5.03; 95% confidence interval (CI): 2.60–9.73; p < 0.001] and all-cause death (HR: 2.80; 95% CI: 1.38–5.69; p = 0.003). The data were similar after multivariable regression analysis.ConclusionNew-onset persistent LBBB after TAVR is associated with insufficient reverse cardiac remodeling and increased adverse clinical events.

【 授权许可】

Unknown