Konstantin Klambauer , Daniel Puhr-Westerheide , Matthias P. Fabritius , Wolfgang G. Kunz , Julien Dinkel , Christine Schmid-Tannwald , Christina Utz , Fabian Grathwohl , Nicola Fink , Konstantinos D. Rizas , Jens Ricke , Michael Ingrisch , Anna T. Stüber , Adrian Curta
{"title":"经胸主动脉瓣置换术后必须植入起搏器的心电图、临床和新型 CT 成像预测因素。","authors":"Konstantin Klambauer , Daniel Puhr-Westerheide , Matthias P. Fabritius , Wolfgang G. Kunz , Julien Dinkel , Christine Schmid-Tannwald , Christina Utz , Fabian Grathwohl , Nicola Fink , Konstantinos D. Rizas , Jens Ricke , Michael Ingrisch , Anna T. Stüber , Adrian Curta","doi":"10.1016/j.ejrad.2024.111835","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Newly onset conduction disturbances with the need for permanent pacemaker (PPM) implantation remain the most common complication of transcatheter aortic valve replacement (TAVR). The objective was to evaluate the predictive value of clinical, ECG and new pre-procedural CT-imaging parameters for the requirement of PPM-implantation after TAVR.</div></div><div><h3>Methods</h3><div>2105 consecutive patients receiving TAVR using a balloon expandable prosthesis (Sapien 3, Edwards Lifesciences, Irving, CA, USA) at our institution were enrolled. Patients receiving a valve-in-valve prosthesis, TAVR after surgical repair, with missing or non-diagnostic CT-scans, with pre-implanted PPM and after TAVR in mitral position were excluded. The most suitable classification model for the given dataset was first identified through benchmark testing and later applied for prediction analysis.</div></div><div><h3>Results</h3><div>312 eligible patients requiring PPM implantation were compared to an age- matched control group of 305 patients not requiring PPM implantation. A scaled LASSO model allowed for most accurate prediction with an AUC of 0.70. Right bundle branch block was the strongest predictor (OR 2.739), followed by atrioventricular block 1° (OR 2.091), prosthesis diameter (OR 1.351), atrial fibrillation (OR 1.255), arterial hypertension (OR 1.215), coronary artery disease (1.070), the angle of ventricle axis and aortic root (OR 1.030), sinotubular junction height (OR 1.014) and the calcification of the left coronary cuspid (OR 1.007).</div></div><div><h3>Conclusions</h3><div>ECG- and clinical outperform imaging parameters in predicting PPM-implantation following TAVR. Right bundle branch block emerged as the most significant predictor overall, while the angle of ventricle axis and aortic root as a novel imaging-based predictor.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"182 ","pages":"Article 111835"},"PeriodicalIF":3.2000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"ECG, clinical and novel CT-imaging predictors of necessary pacemaker implantation after transfemoral aortic valve replacement\",\"authors\":\"Konstantin Klambauer , Daniel Puhr-Westerheide , Matthias P. Fabritius , Wolfgang G. Kunz , Julien Dinkel , Christine Schmid-Tannwald , Christina Utz , Fabian Grathwohl , Nicola Fink , Konstantinos D. Rizas , Jens Ricke , Michael Ingrisch , Anna T. Stüber , Adrian Curta\",\"doi\":\"10.1016/j.ejrad.2024.111835\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Newly onset conduction disturbances with the need for permanent pacemaker (PPM) implantation remain the most common complication of transcatheter aortic valve replacement (TAVR). The objective was to evaluate the predictive value of clinical, ECG and new pre-procedural CT-imaging parameters for the requirement of PPM-implantation after TAVR.</div></div><div><h3>Methods</h3><div>2105 consecutive patients receiving TAVR using a balloon expandable prosthesis (Sapien 3, Edwards Lifesciences, Irving, CA, USA) at our institution were enrolled. Patients receiving a valve-in-valve prosthesis, TAVR after surgical repair, with missing or non-diagnostic CT-scans, with pre-implanted PPM and after TAVR in mitral position were excluded. The most suitable classification model for the given dataset was first identified through benchmark testing and later applied for prediction analysis.</div></div><div><h3>Results</h3><div>312 eligible patients requiring PPM implantation were compared to an age- matched control group of 305 patients not requiring PPM implantation. A scaled LASSO model allowed for most accurate prediction with an AUC of 0.70. Right bundle branch block was the strongest predictor (OR 2.739), followed by atrioventricular block 1° (OR 2.091), prosthesis diameter (OR 1.351), atrial fibrillation (OR 1.255), arterial hypertension (OR 1.215), coronary artery disease (1.070), the angle of ventricle axis and aortic root (OR 1.030), sinotubular junction height (OR 1.014) and the calcification of the left coronary cuspid (OR 1.007).</div></div><div><h3>Conclusions</h3><div>ECG- and clinical outperform imaging parameters in predicting PPM-implantation following TAVR. Right bundle branch block emerged as the most significant predictor overall, while the angle of ventricle axis and aortic root as a novel imaging-based predictor.</div></div>\",\"PeriodicalId\":12063,\"journal\":{\"name\":\"European Journal of Radiology\",\"volume\":\"182 \",\"pages\":\"Article 111835\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-11-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0720048X24005515\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0720048X24005515","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
ECG, clinical and novel CT-imaging predictors of necessary pacemaker implantation after transfemoral aortic valve replacement
Purpose
Newly onset conduction disturbances with the need for permanent pacemaker (PPM) implantation remain the most common complication of transcatheter aortic valve replacement (TAVR). The objective was to evaluate the predictive value of clinical, ECG and new pre-procedural CT-imaging parameters for the requirement of PPM-implantation after TAVR.
Methods
2105 consecutive patients receiving TAVR using a balloon expandable prosthesis (Sapien 3, Edwards Lifesciences, Irving, CA, USA) at our institution were enrolled. Patients receiving a valve-in-valve prosthesis, TAVR after surgical repair, with missing or non-diagnostic CT-scans, with pre-implanted PPM and after TAVR in mitral position were excluded. The most suitable classification model for the given dataset was first identified through benchmark testing and later applied for prediction analysis.
Results
312 eligible patients requiring PPM implantation were compared to an age- matched control group of 305 patients not requiring PPM implantation. A scaled LASSO model allowed for most accurate prediction with an AUC of 0.70. Right bundle branch block was the strongest predictor (OR 2.739), followed by atrioventricular block 1° (OR 2.091), prosthesis diameter (OR 1.351), atrial fibrillation (OR 1.255), arterial hypertension (OR 1.215), coronary artery disease (1.070), the angle of ventricle axis and aortic root (OR 1.030), sinotubular junction height (OR 1.014) and the calcification of the left coronary cuspid (OR 1.007).
Conclusions
ECG- and clinical outperform imaging parameters in predicting PPM-implantation following TAVR. Right bundle branch block emerged as the most significant predictor overall, while the angle of ventricle axis and aortic root as a novel imaging-based predictor.
期刊介绍:
European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field.
Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.