title: Prognostic value of QRS duration after transcatheter aortic valve implantation for aortic stenosis using the CoreValve.
abstract: Transcatheter aortic valve implantation (TAVI) is effective in treating severe aortic stenosis in high-risk surgical patients. We evaluated the value of the QRS duration (QRSd) in predicting the mid-term morbidity and mortality after TAVI. We conducted a prospective cohort study of 91 consecutive patients who underwent TAVI using the CoreValve at our teaching hospital cardiology unit in 2008 to 2010 who survived to hospital discharge; 57% were women, and their mean age was 84 ± 7 years. The QRSd at discharge was used to classify the patients into 3 groups: QRSd ≤120 ms, n = 18 (20%); QRSd >120 ms but ≤150 ms, n = 30 (33%); and QRSd >150 ms, n = 43 (47%). We used 2 end points: (1) all-cause mortality and (2) all-cause mortality or admission for heart failure. After a median of 12 months, the normal-QRSd patients showed a trend toward, or had, significantly better overall survival and survival free of admission for heart failure compared with the intermediate-QRSd group (p = 0.084 and p = 0.002, respectively) and the long-QRSd group (p = 0.015 and p = 0.001, respectively). The factors significantly associated with all-cause mortality were the Society of Thoracic Surgeons score, aortic valve area, post-TAVI dilation, acute kidney injury, hospital days after TAVI, and QRSd at discharge. On multivariate analysis, QRSd was the strongest independent predictor of all-cause mortality (hazard ratio 1.036, 95% confidence interval 1.016 to 1.056; p <0.001) and all-cause mortality or heart failure admission (hazard ratio 1.025, 95% confidence interval 1.011 to 1.039; p <0.001). The other independent predictors were the Society of Thoracic Surgeons score, acute kidney injury, and post-TAVI hospital days. In conclusion, a longer QRSd after TAVI was associated with greater morbidity and mortality after 12 months. The QRSd at discharge independently predicted mortality and morbidity after TAVI.
authors.affiliation: Interventional Cardiology Unit, Henri Mondor University Hospital, Val-de-Marne University, Creteil, France. meguro@med.email.ne.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Meguro
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Emilie
authors.initials: E
authors.lastname: Fougeres
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Monin
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Rande
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome