Journal of electrocardiology · 2026
Post procedural changes in frontal QRS-T angle predict electrical disturbances after self-expandable transcatheter aortic valve implantation.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Alıç Enes, Onaç Mehdi, Niang Mohamed, Gökalp Murat, Özyılmaz Sinem Özbay, Huraibat Ahmad, Tüner Haşim, Vatankulu Mehmet Akif, Uçar Hakan
Аннотация
BACKGROUND: Electrical disturbances are common complications after transcatheter aortic valve implantation (TAVI), particularly with self-expandable valves. Improved noninvasive markers are needed to identify patients at increased risk. The frontal QRS-T angle reflects ventricular electrical heterogeneity, but the prognostic value of its post-procedural change remains unclear.
METHODS: In this single-center retrospective observational cohort study, consecutive patients undergoing self-expandable TAVI were analyzed. ΔQRS-T angle was defined as the difference between post and pre-procedural frontal QRS-T angles. The primary endpoint was the occurrence of electrical disturbances within 24 h, including new-onset bundle branch block, QRS prolongation >20 ms, high-grade atrioventricular block, or permanent pacemaker implantation (PPM). Logistic regression and receiver operating characteristic (ROC) analyses were performed.
RESULTS: A total of 135 patients were included, of whom 66 (48.9%) developed electrical disturbances. ΔQRS-T angle was significantly greater in patients with electrical disturbances (median 24° vs. 7°, p = 0.01). In multivariable analysis, ΔQRS-T angle independently associated with electrical disturbances (odds ratio [OR] 1.02 per degree increase, 95% confidence interval [CI] 1.01-1.03, p = 0.006) and PPM implantation (OR 1.016 per degree increase, 95% CI 1.01-1.07, p = 0.02). ROC analysis demonstrated modest discrimination (area under the curve 0.619, 95% CI 0.519-0.719). A cut-off value of 46.5° yielded 45.5% sensitivity and 87.0% specificity.
CONCLUSIONS: Post-procedural change in frontal QRS-T angle is independently associated with early electrical disturbances and pacemaker requirement after self-expandable TAVI. ΔQRS-T angle may provide complementary risk information but requires external validation before routine clinical application.
METHODS: In this single-center retrospective observational cohort study, consecutive patients undergoing self-expandable TAVI were analyzed. ΔQRS-T angle was defined as the difference between post and pre-procedural frontal QRS-T angles. The primary endpoint was the occurrence of electrical disturbances within 24 h, including new-onset bundle branch block, QRS prolongation >20 ms, high-grade atrioventricular block, or permanent pacemaker implantation (PPM). Logistic regression and receiver operating characteristic (ROC) analyses were performed.
RESULTS: A total of 135 patients were included, of whom 66 (48.9%) developed electrical disturbances. ΔQRS-T angle was significantly greater in patients with electrical disturbances (median 24° vs. 7°, p = 0.01). In multivariable analysis, ΔQRS-T angle independently associated with electrical disturbances (odds ratio [OR] 1.02 per degree increase, 95% confidence interval [CI] 1.01-1.03, p = 0.006) and PPM implantation (OR 1.016 per degree increase, 95% CI 1.01-1.07, p = 0.02). ROC analysis demonstrated modest discrimination (area under the curve 0.619, 95% CI 0.519-0.719). A cut-off value of 46.5° yielded 45.5% sensitivity and 87.0% specificity.
CONCLUSIONS: Post-procedural change in frontal QRS-T angle is independently associated with early electrical disturbances and pacemaker requirement after self-expandable TAVI. ΔQRS-T angle may provide complementary risk information but requires external validation before routine clinical application.