预测跨导管大动脉替换后心脏起器依赖:对心电图,临床和CT成像参数的分析
Konstantin Klambauer1, Konstantinos D Rizas2, Matthias P Fabritius1
1Department of Radiology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
European journal of radiology
|November 22, 2025
概括
在过导管大动脉置换 (TAVR) 之前,右捆支部阻塞是心脏起器依赖的最强有力的预测因素. 假肢超大尺寸和左冠状动脉尖端化也预测了TAVR后需要永久起器的需求.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏电生理学 心脏电生理学
背景情况:
- 需要永久心脏起器 (PPM) 植入的导电障碍是跨导管大动脉置换 (TAVR) 的已知并发症.
- 使用心电图,临床和CT成像进行TAVR后的PPM依赖的预测因素尚未得到充分确立.
研究的目的:
- 为了确定患者需要PPM植入后TAVR与SAPIEN 3假肢的节拍器依赖的预测因素.
- 用关键变量与综合模型对比,评估有限模型的预测准确度.
主要方法:
- 连续接受了用SAPIEN 3假肢进行 transfemoral TAVR 的患者的回顾性分析 (2012年5月 - 2019年12月).
- 在PPM植入后的第一次随访时,PPM依赖度定义为≥1%的心室节奏.
- 多变量回归分析以确定预测因素并比较预测模型.
主要成果:
- 16.6% (350/2105) 的患者需要TAVR后的PPM;包括301名患者在分析中.
- 在55.8% (168/301) 的患者中观察到PPM依赖.
- 对PPM依赖的重要预测因素是:假肢过大 (OR 1.09),左冠状动脉尖端下方的化 (OR 1.02),以及TAVR前的右束分支块 (OR 2.20).
结论:
- 在TAVR前的右捆分支块是PPM依赖的最强的预测因素.
- 假肢超大尺寸和左冠状动脉尖端化也是重要的预测因素.
- 结合这些因素的有限预测模型显示预测准确度中等 (AUC 0.752).
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