SPC365

Prognostic Value of QRS Variation Following TAVI: A Predictor of Left Ventricular Dysfunction and Mortality at 1-Year Follow up

Session: SESSÃO DE POSTERS 05 - TAVI 1
Speaker: Catarina Lagoas Pohle

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Catarina Lagoas Pohle; André Lobo; Marta Catarina Almeida; Pedro Braga; Daniel Caeiro; Ricardo Fontes-Carvalho
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Introduction </span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Conduction abnormalities are common following TAVI, with post-TAVI QRS duration (QRSd) often studied as a predictor of adverse outcomes. However, the prognostic significance of QRSd variation&mdash;the change from baseline QRSd to post-TAVI QRSd&mdash;has received less attention. This study aims to evaluate the relationship between QRS variation and adverse outcomes and compares its prognostic utility with post-TAVI QRSd alone.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Methods </span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">A single-center retrospective analysis was conducted on TAVI patients from 2015 to 2021, excluding those with prior pacemakers or with insufficient data. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Primary endpoint was a composite of worsening left ventricular ejection fraction (LVEF) at 1 year (defined as a reduction of more than 10 percentage points from pre-TAVI to 1-year follow-up (FUP)) and all-cause mortality at 1year FUP.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Results </span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">A total of 296 patients were included (mean age 80 &plusmn;7 years). Prior to TAVI, 5.1% (n=15) of patients had pre-existing left bundle branch block (LBBB) and 7.4% (n=22) had pre-existing right bundle branch block (RBBB).&nbsp; During in-hospital stay following TAVI, 33.8% (n=100) of patients developed new-onset LBBB, 1.4% (n=4) developed RBBB, and 11.2% (n=29) required pacemaker implantation.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Median QRSd increased from 101ms (IQR 27) before TAVI to 126ms (IQR 50) immediately after the procedure, and to 114ms (IQR 49) at discharge, with a mean inicial QRSd increase of 19&plusmn;26ms and 18&plusmn;26ms at discharge.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">One year after TAVI, patients with new-onset sustained rhythm disturbances had a significantly lower mean LVEF (50.0%, IQR 14.8) compared to those without rhythm disturbances (58.0%, IQR 8.0; p&lt;0.001).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">In the univariate analysis for the primary endpoint, QRSd variation at discharge demonstrated the highest predictive value (Wald 11.383, p= 0.001), followed by new onset persistent LBBB at 1 year FUP (Wald 9.141, p=0.002) and QRSd variation immediately after TAVI (Wald 6.609, p=0.010). QRSd immediately after TAVI or at discharge did not show statistical significance as predictors of the primary outcome (p=0.188 and p=0.062, respectively), as presented in Table 1.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">QRSd variation at discharge was the only independent predictor of the composite endpoint of worsening LVEF and all-cause mortality at 1-year follow-up. Each 1-ms increase in QRSd variation was associated with a 3.8% higher odds of reaching the composite endpoint (OR 1.038, 95% CI 1.009&ndash;1.069; Wald Chi-Square = 6.520; p = 0.011).</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">Conclusion </span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;">This study highlights the QRSd variation may offer a dynamic assessment of risk, particularly for LVEF worsening and mortality at 1 year FUP, especially in comparison to QRSd alone. The identification of optimal QRSd variation thresholds could help enhance clinical decision-making and patient outcomes.</span></span></span></span></span></p>