Impact on clinical outcome of ventricular arrhythmias in patients undergoing transcatheter aortic valve implantation.

IF 2.9 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Medicine Pub Date : 2024-04-01 Epub Date: 2024-02-12 DOI:10.2459/JCM.0000000000001596

Nello Cambise, Eleonora Gnan, Saverio Tremamunno, Alessandro Telesca, Antonietta Belmusto, Lorenzo Tinti, Antonio Di Renzo, Cristina Aurigemma, Francesco Burzotta, Carlo Trani, Filippo Crea, Gaetano Antonio Lanza

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Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become a largely used treatment for severe aortic stenosis. There are limited data, however, about predictors of long-term prognosis in this population. In this study, we assessed whether ventricular arrhythmias may predict clinical outcomes in patients undergoing TAVI.

Methods and results: We performed a 24 h ECG Holter monitoring in 267 patients who underwent TAVI for severe aortic stenosis within 30 days from a successful procedure. The occurrence of frequent premature ventricular complexes (PVCs; ≥30/h), polymorphic PVCs and nonsustained ventricular tachycardia (NSVT) was obtained for each patient. Clinical outcome was obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Cardiovascular events (CVEs; cardiovascular death or resuscitated cardiac arrest) occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs but not polymorphic PVCs and NSVT were found to be associated with CVEs at univariate analysis. Frequent PVCs were indeed found in 12 patients with (46.2%) and 35 without (17.3%) CVEs [hazard ratio 2.30; 95% confidence interval (CI) 1.03-5.09; P = 0.04], whereas polymorphic PVCs were found in 11 (42.3%) and 54 (26.7%) patients of the two groups, respectively (hazard ratio 1.44; 95% CI 0.64-3.25; P = 0.38), and NSVT in 9 (34.6%) and 43 patients of the two groups, respectively (hazard ratio 1.18; 95% CI 0.48-2.87; P = 0.72). Frequent PVCs, however, were not significantly associated with CVEs at multivariate Cox regression analysis (hazard ratio 1.53; 95% CI 0.37-6.30; P = 0.56). Both frequent PVCs, polymorphic PVCs and NSVT showed no significant association with mortality.

Conclusion: In our study, the detection of frequent PVCs at Holter monitoring after TAVI was a predictor of CVEs (cardiovascular death/cardiac arrest), but this association was lost in multivariable analysis.

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经导管主动脉瓣植入术患者室性心律失常对临床结果的影响。

背景：经导管主动脉瓣植入术（TAVI）已成为治疗严重主动脉瓣狭窄的常用方法。然而，有关该人群长期预后预测的数据却很有限。在这项研究中，我们评估了室性心律失常是否可以预测接受 TAVI 患者的临床预后：我们对 267 名因重度主动脉瓣狭窄接受 TAVI 的患者进行了 24 小时心电图 Holter 监测，监测时间为手术成功后 30 天内。获得了每位患者频发室性早搏（PVC；≥30/h）、多形性室性早搏和非持续性室性心动过速（NSVT）的发生率。228 名患者（85%）获得了临床结果，平均随访 3.5 年（1.0-8.6 年）。26名患者（11.4%）发生了心血管事件（CVE；心血管死亡或复苏后心脏骤停），63名患者死亡（27.6%）。单变量分析发现，频发 PVC 与 CVEs 相关，但多态 PVC 和 NSVT 不相关。在 12 例（46.2%）和 35 例（17.3%）CVE 患者中确实发现了频发 PVC[危险比 2.30；95% 置信区间（CI）1.03-5.09；P = 0.04]，而在两组患者中分别有 11 例（42.3%）和 54 例（26.7%）发现了多形性 PVC。7%）的患者中发现多形性 PVC（危险比 1.44；95% CI 0.64-3.25；P = 0.38），两组患者中分别有 9 例（34.6%）和 43 例（危险比 1.18；95% CI 0.48-2.87；P = 0.72）发现 NSVT。然而，在多变量考克斯回归分析中，频繁的 PVC 与 CVE 并无明显关联（危险比 1.53；95% CI 0.37-6.30；P = 0.56）。频发 PVC、多态 PVC 和 NSVT 均与死亡率无明显关联：在我们的研究中，TAVI术后Holter监测发现的频发PVC是CVE（心血管死亡/心脏骤停）的预测因子，但在多变量分析中这种关联消失了。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Medicine 医学-心血管系统

CiteScore

3.90

自引率

26.70%

发文量

189

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Medicine is a monthly publication of the Italian Federation of Cardiology. It publishes original research articles, epidemiological studies, new methodological clinical approaches, case reports, design and goals of clinical trials, review articles, points of view, editorials and Images in cardiovascular medicine. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.