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Schamroth Pravda N, Shaleve Y, Plakht Y, Shafir G, Grinberg T, Wiessman M, Aviv Y, Vaknin Assa H, Codner P, Golovchiner G, Barsheshet A, Kornowski R, Shiyovich A, Hamdan A. Interventricular septal thickness on cardiac computed tomography as a novel risk factor for conduction disturbances in patients undergoing transcatheter aortic valve replacement. Europace 2024; 26:euae113. [PMID: 38691562 PMCID: PMC11094757 DOI: 10.1093/europace/euae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/28/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS We examined whether thickness of the basal muscular interventricular septum (IVS), as measured by pre-procedural computed tomography (CT), could be used to identify the risk of conduction disturbances following transcatheter aortic valve replacement (TAVR). The IVS is a pivotal region of the electrical conduction system of the heart where the atrioventricular conduction axis is located. METHODS AND RESULTS Included were 78 patients with severe aortic stenosis who underwent CT imaging prior to TAVR. The thickness of muscular IVS was measured in the coronal view, in systolic phases, at 1, 2, 5, and 10 mm below the membranous septum (MS). The primary endpoint was a composite of conduction disturbance following TAVR. Conduction disturbances occurred in 24 out of 78 patients (30.8%). Those with conduction disturbances were significantly more likely to have a thinner IVS than those without conduction disturbances at every measured IVS level (2.98 ± 0.52 mm vs. 3.38 ± 0.52 mm, 4.10 ± 1.02 mm vs. 4.65 ± 0.78 mm, 6.11 ± 1.12 mm vs. 6.88 ± 1.03 mm, and 9.72 ± 1.95 mm vs. 10.70 ± 1.55 mm for 1, 2, 5 and 10 mm below MS, respectively, P < 0.05 for all). Multivariable logistic regression analysis showed that pre-procedural IVS thickness (<4 mm at 2 mm below the MS) was a significant independent predictor of post-procedural conduction disturbance (adjOR 7.387, 95% CI: 2.003-27.244, P = 0.003). CONCLUSION Pre-procedural CT assessment of basal IVS thickness is a novel predictive marker for the risk of conduction disturbances following TAVR. The IVS thickness potentially acts as an anatomical barrier protecting the underlying conduction system from mechanical compression during TAVR.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Yonatan Shaleve
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
- Internal Medicine ‘F’ (Recanati), Rabin Medical Center, Petach Tikva, Israel
| | - Ygal Plakht
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, and Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Gideon Shafir
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Tzil Grinberg
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Maya Wiessman
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Yaron Aviv
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Gregory Golovchiner
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49414, Israel
- Faculty of Medicine, Tel Aviv University, P.O.B 39040 Ramat Aviv, Tel Aviv 69978, Israel
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Peng Y, Hu H, Shu X, Lin Y, Huang W, Xu S, Nie R. The myth of aortic valve annulus changes in aortic valve disease. Front Cardiovasc Med 2023; 10:1302992. [PMID: 38162138 PMCID: PMC10755897 DOI: 10.3389/fcvm.2023.1302992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background The characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established. Objective This study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases. Methods A retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients). Results Typically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively. Conclusions Systolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.
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Affiliation(s)
- Yanren Peng
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China
| | - Xiaorong Shu
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yongqing Lin
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Weibin Huang
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Shuwan Xu
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Ruqiong Nie
- Department of Cardiovascular Medicine, Sun Yat-sen Memorial Hospital, Guangzhou, China
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