title: Aortic annulus to left coronary distance as a predictor for persistent left bundle branch block after TAVI.
abstract: OBJECTIVE
  To identify potential predictors for ventricular conduction delay and to evaluate the impact of interventricular dyssynchrony on mortality after implantation of a balloon-expandable aortic valve (BEV).
  
  
  RESULTS
  Clinical, computertomographical (CT), and electrocardiographical (ECG) data from 225 transcatheter aortic valve implantation (TAVI) patients were analyzed. Procedures were performed between May 2010 and September 2013 via transfemoral access using a BEV. Incidence of new-onset left bundle branch block (NOP-LBBB) at discharge was 23.1% (n = 52). Predictive factors for NOP-LBBB were first degree atrioventricular (AV) block (odds ratio (OR): 3.91, 95% confidence interval (CI): 1.58 to 9.64), area cover index (OR: 1.83, 95% CI: 1.26 to 2.67), annulus calcification > first degree (OR: 3.01, 95% CI: 1.36 to 6.66), and annulus to left coronary distance (OR: 0.65, 95% CI: 0.44 to 0.96). At 1-year follow-up, no significant difference was observed concerning all-cause mortality (15.6% among non NOP-LBBB and 9.6% among NOP-LBBB patients, P = 0.278) and cardiovascular mortality (4.6% among non NOP-LBBB and 5.8% among NOP-LBBB patients, P = 0.737).
  
  
  CONCLUSIONS
  In addition to previous predictors, annulus to left coronary distance and area cover index have been identified as new predictors for NOP-LBBB. NOP-LBBB showed no relevant impact on mortality after one year. Further investigation including larger populations and longer follow-up is required to confirm these findings and develop an algorithm for identification of patients at risk for NOP-LBBB associated adverse events. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Hein-Rothweiler
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.|Munich Heart Alliance at DZHK, Munich, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Jochheim
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Rizas
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Egger
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Theiss
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.|Munich Heart Alliance at DZHK, Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.|Munich Heart Alliance at DZHK, Munich, Germany.
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
mesh_terms: D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology*; D006328:Cardiac Catheterization; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic valve disease; electron beam CT/multidetector CT; imaging; percutaneous intervention; risk stratification; statistical analysis