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Published on: February 4, 2021
LDL-C: An Important Independent Risk Factor for New-Onset Heart Block in Patients with Severe Aortic Stenosis and
Mei Dong1, Lizhen Wang1, Gary Tse2,3,4
1Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000 Yantai, Shandong, China.
Insights
New heart block after transcatheter aortic valve replacement (TAVR) is common. High LDL cholesterol and prolonged QRS duration before TAVR are key risk factors for developing heart block.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Transcatheter aortic valve replacement (TAVR) offers an alternative for patients with aortic stenosis (AS) at high surgical risk.
- Conduction abnormalities, particularly heart block, are frequent complications post-TAVR, potentially impacting procedural success.
- Identifying risk factors for new-onset heart block is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the risk factors associated with new-onset conduction abnormalities following TAVR.
- To provide clinical insights for the prevention and management of post-TAVR heart block.
Main Methods:
- A cohort of 93 patients undergoing TAVR was analyzed.
- Patients were categorized based on the development of heart block post-procedure.
- Logistic regression analysis was employed to identify significant risk factors, including clinical characteristics, procedural data, and ECG parameters.
Main Results:
- 34.4% of patients developed heart block after TAVR.
- Univariate analysis identified malignancy history, atrial fibrillation, high LDL-C, and prolonged QRS, QT, and QTc intervals as potential risk factors.
- Multivariate analysis confirmed high LDL-C and prolonged QRS interval as independent predictors of heart block.
Conclusions:
- Heart block is a significant complication following TAVR.
- Elevated LDL-C and a prolonged QRS interval pre-TAVR are identified as independent risk factors for developing heart block.
Background:
Transcatheter aortic valve replacement (TAVR) is an effective alternative treatment for patients with aortic stenosis (AS) who have intermediate to high surgical risk or who are inoperable. However, the incidence of conduction abnormalities is high after TAVR, which can reduce the effectiveness of the surgery. Our research objective is to explore the risk factors of new-onset conduction abnormalities after TAVR, providing reference value for clinical doctors to better prevent and treat conduction abnormalities.
Methods:
Patients who underwent TAVR were divided into those who developed heart block and those who did not. Baseline clinical characteristics, cardiac structural parameters, procedural characteristics, electrocardiogram (ECG) changes before and after TAVR ( = postoperative minus preoperative), and surgical complications were compared. Logistic regression was applied to identify significant risk factors for new-onset heart block.
Results:
We studied 93 patients, of whom 34.4% developed heart blocks. Univariate logistic regression showed that prior history of malignancy, atrial fibrillation, preoperative high-level total cholesterol and low-density lipoprotein cholesterol (LDL-C), HR, QRS interval, QT interval, and QTc interval were risk factors of new-onset heart block after TAVR. Multivariate analysis showed that preoperative high-level LDL-C and QRS interval remained significant independent risk factors after adjusting for potential confounds.
Conclusions:
Heart block is the most common complication of TAVR, and its significant independent risk factors include high-level LDL-C and QRS interval.
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