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Can aortic valve calcium score predict a need for permanent pacemaker implantation after transcatheter aortic valve
Thomas Barbe1, Charles Fauvel1, Thibaut Hemery1
1Department of Cardiology, Inserm U1096, Univ Rouen Normandie, CHU Rouen, Rouen, France.
Insights
High aortic valve calcium score (AVCS) can help identify patients needing a permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI). This finding aids in predicting PPM risk, especially in patients without pre-existing right bundle branch block.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Conductive disturbances requiring permanent pacemaker (PPM) implantation are a significant concern following transcatheter aortic valve implantation (TAVI).
- Predicting the need for PPM post-TAVI is crucial for patient management and outcomes.
Purpose of the Study:
- To evaluate the impact of aortic valve calcium score (AVCS) on the incidence of conductive disturbances requiring PPM after TAVI.
- To determine if AVCS offers incremental prognostic value beyond established risk factors for PPM.
Main Methods:
- Retrospective analysis of 761 patients undergoing TAVI with available preprocedural CT scans for AVCS assessment.
- Primary endpoint: occurrence of conductive disturbances requiring PPM within 30 days post-TAVI.
- Multivariable logistic regression, ROC curve analysis, and likelihood ratio tests were used to analyze the association between AVCS, other risk factors, and PPM.
Main Results:
- 125 patients (16%) required PPM at 30 days.
- Higher AVCS was observed in patients who required PPM (3788 AU vs 3050 AU, p<0.001).
- Independent predictors for PPM included right bundle branch block (RBBB), first-degree atrioventricular block, self-expanding valve use, and AVCS > 4510 AU.
- AVCS demonstrated incremental discriminative value for PPM prediction (C-index 0.79).
Conclusions:
- While RBBB remains the strongest predictor of PPM post-TAVI, elevated AVCS is independently associated with increased PPM risk.
- High AVCS can aid in identifying patients at higher risk for PPM, particularly those without pre-existing RBBB.
- An algorithm incorporating RBBB, AVCS, and valve type is proposed for PPM risk stratification.
Introduction:
Conductive disturbances requiring permanent pacemaker (PPM) implantation remain a major concern after transcatheter aortic valve implantation (TAVI).
Aims:
To assess the impact of aortic valve calcium score (AVCS) on conductive disturbances requiring PPM after TAVI.
Methods:
All patients who underwent TAVI with accessible AVCS from the preprocedural CT scan report were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disturbance requiring PPM at 30 days. The association between PPM and AVCS, with its incremental prognostic value, was analysed using multivariable logistic regression, receiver operating characteristic curve analysis and likelihood ratio (LR) test.
Results:
We included 761 patients of which 125 (16%) required PPM at 30 days. AVCS score was significantly higher in patients requiring PPM (3788 (2487-5218) vs 3050 (2043-4367) AU, p<0.001). Using multivariable analysis, preprocedural right bundle branch block (RBBB) (OR 6.61, 95% CI 3.82 to 11.5, p<0.001), first atrioventricular block (OR 1.71, 95% CI 1.03 to 2.83, p=0.037), self-expanding valve (OR 3.25, 95% CI 1.17 to 9.09, p=0.025) and AVCS>4510 AU (OR 1.83, 95% CI 1.04 to 3.20, p=0.035) were independently associated with PPM. AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPM risk factors. An algorithm was proposed based on the initial presence of RBBB, AVCS and the type of implanted valve.
Conclusion:
Even if RBBB remained the strongest predictor of PPM post-TAVI, this study suggests that a high AVCS may help identifying patients at increased risk of PPM after TAVI, especially among those without pre-existing RBBB.
