Journal of cardiovascular computed tomography · 2025
Membranous septum area and the risk of conduction abnormalities following transcatheter aortic valve implantation.
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Pavitt Christopher, Bagnall Timothy, Smethurst James, Mcinerney-Baker George, Arunothayaraj Sandeep, Broyd Christopher, Michail Michael, Cockburn James, Hildick-Smith David
Аннотация
BACKGROUND: Conduction abnormalities (CA) after TAVI remain problematic. Membranous septum (MS) depth correlates inversely with new CA though within-patient variability exists.
OBJECTIVES: To determine the association of CT-derived MS area with new CA after TAVI.
METHODS: MS depth was measured along its width (20 % intervals) to calculate MS area in 140 patients without CA. The primary outcome was PPI or new persistent LBBB at discharge.
RESULTS: New CA occurred in 49 (35 %) patients of whom 10 (7.1 %) required PPI and 39 (27.9 %) developed persisting LBBB. MS area was significantly smaller in those with new CA (20.1 [8.6] vs. 41.2 [18.0] mm2; p < 0.01). By multivariable regression, a model including MS area and TAVI contact (MS width∗implant depth): MS area ratio showed better discrimination for new CA compared with a model including MS depth and MS depth - implant depth (AUC 0.89 [95 % CI 0.83-0.94] vs. 0.84 [95 % CI 0.76-0.90]; p = 0.05, respectively). Optimal cut off point for correct classification of new CA for MS depth was 3.9 mm (sensitivity 73 %, specificity 76 %, PPV 58 % and NPV 84 %), 28.0 mm2 for MS area (sensitivity 88 %, specificity 78 %, PPV 68 % and NPV 92 %) and 1.88 (sensitivity 63 %, specificity 81, PPV 77 % and NPV 68 %) for TAVI contact: MS area ratio. To minimize new CA, maximal valve implant depth should ≤ (1.88 ∗ MS area)/MS width.
CONCLUSIONS: Pre-procedural assessment of the MS area offers additional predictive value for development of new conduction abnormalities after TAVI when compared with MS depth and can guide implant depth.
OBJECTIVES: To determine the association of CT-derived MS area with new CA after TAVI.
METHODS: MS depth was measured along its width (20 % intervals) to calculate MS area in 140 patients without CA. The primary outcome was PPI or new persistent LBBB at discharge.
RESULTS: New CA occurred in 49 (35 %) patients of whom 10 (7.1 %) required PPI and 39 (27.9 %) developed persisting LBBB. MS area was significantly smaller in those with new CA (20.1 [8.6] vs. 41.2 [18.0] mm2; p < 0.01). By multivariable regression, a model including MS area and TAVI contact (MS width∗implant depth): MS area ratio showed better discrimination for new CA compared with a model including MS depth and MS depth - implant depth (AUC 0.89 [95 % CI 0.83-0.94] vs. 0.84 [95 % CI 0.76-0.90]; p = 0.05, respectively). Optimal cut off point for correct classification of new CA for MS depth was 3.9 mm (sensitivity 73 %, specificity 76 %, PPV 58 % and NPV 84 %), 28.0 mm2 for MS area (sensitivity 88 %, specificity 78 %, PPV 68 % and NPV 92 %) and 1.88 (sensitivity 63 %, specificity 81, PPV 77 % and NPV 68 %) for TAVI contact: MS area ratio. To minimize new CA, maximal valve implant depth should ≤ (1.88 ∗ MS area)/MS width.
CONCLUSIONS: Pre-procedural assessment of the MS area offers additional predictive value for development of new conduction abnormalities after TAVI when compared with MS depth and can guide implant depth.