经导管主动脉瓣置换术后新发传导阻滞的危险因素分析及预测

Prediction and risk factor analysis of new-onset conduction disturbance after transcatheter aortic valve replacement

目的探究经导管主动脉瓣置换术(TAVR)后新发传导阻滞(NOCD)的相关因素,建立预测模型对传导阻滞发生风险进行评估。方法纳入2016年1月至2022年3月中南大学湘雅二医院行TAVR的症状性重度主动脉瓣狭窄或重度主动脉瓣反流的184例患者,通过医院信息系统和影像数据库收集患者的人口学、病史、检查结果、影像图像等临床数据,测量人工瓣膜置入深度等传导阻滞相关数据,由专科医师对心电图、超声心动图、CT血管造影(CTA)、手术资料等进行数据的提取和分析。使用SPSS软件对数据进行统计学分析,构建NOCD的多因素Logistic回归预测模型。结果以TAVR术后NOCD作为结局事件,184例患者分为NOCD组(57例)和非NOCD组(127例)。TAVR术后NOCD发生率为31.0%,单纯重度主动脉瓣反流患者TAVR术后NOCD发生率为63.6%(7/11)。NOCD组较非NOCD组的主动脉角度更大[(57.7±10.3)°比(52.0±9.0)°,P<0.001]、锚定区尺寸比更大[(129±28)%比(120±21)%,P=0.018]、人工瓣膜置入位置更深[(7.2±5.1)mm比(4.8±4.2)mm,P=0.001],并且单纯重度主动脉瓣反流患者比例更高[12.3%比3.1%,P=0.037],差异均有统计学意义。通过多因素Logistic回归分析显示主动脉角度>54.5°(OR 3.78,95%CI 1.86~7.63,P<0.001)和人工瓣膜置入深度>5.7 mm(OR 3.39,95%CI 1.68~6.85,P<0.001)是TAVR术后NOCD的独立危险因素,并建立了以主动脉角度>54.5°、人工瓣膜置入深度>5.7 mm和锚定区尺寸比>122.9%为变量的预测模型。受试者工作特征曲线下面积(AUC)0.709(95%CI 0.623~0.795),可预测TAVR术后NOCD。结论主动脉角度>54.5°和人工瓣膜置入深度>5.7 mm是TAVR术后NOCD的独立危险因素。

Objective To explore the relevant factors of new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR),such as anatomical structure,device type,surgical strategies,etc.,discover relevant predictive factors,and establish a predictive model to assess the risk of conduction blockages.Methods From January 2016 to March 2022,clinical data of symptomatic patients with severe aortic valve stenosis or severe regurgitation who underwent TAVR at Xiangya Second Hospital of Central South University were collected through the hospital information system and imaging database.ECG,echocardiography,CTA,surgical materials,etc.,were extracted and analyzed by specialists.SPSS software was used for statistical analysis,and a multi-factor regression prediction model for NOCDwas built.Results A total of 184 patients were included,the occurrence rate of NOCD after TAVR was 31.0%,pure regurgitation patients’NOCD occurrence rate was 63.6%(7/11).The NOCD group had a larger aortic angles[(57.7±10.3)°vs.(52.0±9.0)°,P<0.001],larger Oversizing[(129±28)%vs.(120±21)%,P=0.018],deeper implantation depth[(7.2±5.1)mm vs.(4.8±4.2)mm,P=0.001],and higher pure regurgitation patients’proportion[12.3%vs.3.1%,P=0.037]than the non-NOCD group.Multifactorial Logistic regression analysis indicated that an aorta angle>54.5°(OR 3.78,95%CI 1.86-7.63,P<0.001)or implantation depth>5.7 mm(OR 3.39,95%CI 1.68-6.85,P<0.001)are independent risk factors for new onset conduction disturbances after TAVR,and a predictive model was established with aortic angle,implantation depth,and Oversizing ratio as variables.The receiver operating characteristics curve showed area under ROC curve 0.709,95%CI 0.623–0.795,predicting NOCD after TAVR.Conclusions A retrospective analysis carried out at a single center discovered that the aortic angle in the NOCD group was larger than that in the non-NOCD group,the Oversizing ratio was higher,the implantation location was deeper,and there was a higher proportion of patients with pure regurgitation lesions.An aortic angle greater than 54.5°or an implantation depth more than 5.7 mm were identified as independent risk factors for NOCD after TAVR.