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Kaya E, Andresen K, Lie ØH, Aaberge L, Haugaa KH, Edvardsen T, Skulstad H. Left ventricular mechanical dispersion as a predictor of the need for pacemaker implantation after transcatheter aortic valve implantation: MeDiPace TAVI study. Eur Heart J Cardiovasc Imaging 2024; 25:539-547. [PMID: 37976177 DOI: 10.1093/ehjci/jead315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS Permanent pacemaker (PM) implantation is common after transcatheter aortic valve implantation (TAVI). Left ventricular mechanical dispersion (MeDi) by speckle tracking echocardiography is a marker of fibrosis that causes alterations in the conduction system. We hypothesized that MeDi can be a predictor of the need for PM implantation after TAVI. METHODS AND RESULTS Consecutively, 200 TAVI patients were enrolled. Transthoracic echocardiography and electrocardiography examinations were recorded before TAVI to evaluate global longitudinal strain (GLS), MeDi, and conduction disturbances. PM implantation information was obtained 3 months after TAVI. Patients were stratified into PM or no PM group. Mean age was 80 + 7 years (44% women). Twenty-nine patients (16%) received PM. MeDi, QRS duration, existence of right bundle branch abnormality (RBBB), and first-degree atrioventricular (AV) block were significantly different between groups. MeDi was 57 ± 15 ms and 48 ± 12 ms in PM and no PM groups, respectively (P < 0.001). In multivariate analysis, MeDi predicted the need for PM after TAVI independently of GLS, QRS duration, RBBB, and first-degree AV block [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.22-2.45] with an area under the curve (AUC) of 0.68 in receiver operating characteristic (ROC) curves. Moreover, RBBB was an independent predictor of PM need after TAVI (OR: 8.98, 95% CI: 1.78-45.03). When added to RBBB, MeDi had an incremental predictive value with an AUC of 0.73 in ROC curves (P = 0.01). CONCLUSION MeDi may be used as an echocardiographic functional predictor of the need for PM after TAVI.
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Affiliation(s)
- Esra Kaya
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Institude for Surgical Research, Oslo University Hospital, Sognsvannsveien 20,0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Kristoffer Andresen
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institude of Clinical Medicine, University of Oslo, Blindern 0318, Oslo, Norway
| | - Øyvind H Lie
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institude of Clinical Medicine, University of Oslo, Blindern 0318, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institude of Clinical Medicine, University of Oslo, Blindern 0318, Oslo, Norway
| | - Helge Skulstad
- Department of Cardiology, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Institude for Surgical Research, Oslo University Hospital, Sognsvannsveien 20,0372 Oslo, Norway
- PROCARDIO-Center for Innovation, Clinic of Heart, Lung and Vessel Disease, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institude of Clinical Medicine, University of Oslo, Blindern 0318, Oslo, Norway
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