Possible predictive role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients: preliminary data

Abstract

ObjectivesTo evaluate the predicative power of the electrical risk score (ERS), a noninvasive and inexpensive test obtained by means of a standard 12-lead electrocardiogram (ECG), in a cohort of elderly patients who had undergone transcatheter aortic valve replacement (TAVR).MethodsSurvivors and non-survivors after TAVR at 1-year follow-up were compared in respect to the pre-procedural ERS as well as a number of other clinical and instrumental variables. ERS is composed of seven simple ECG markers: heart rate (>75 bpm); QRS duration (>110 ms); left ventricular hypertrophy (Sokolow–Lyon criteria); delayed QRS transition zone (≥ V4); frontal QRS-T angle (>90°); long QTBazett (>450 ms for men and >460 in women) or JTBazett (330 ms for men and >340 ms for women); and long Tpeak to Tend interval (Tp-e) (>89 ms). The trial was registered in ClinicalTrials.gov as NCT03145376.ResultsA total of 40 patients were evaluated. During the follow-up, the all-cause mortality rate was 25% (ten patients) with 15% of cardiovascular death (six patients). The ERS was the strongest predictor of all-cause (odds ratio 3.73, 95% CI: 1.44–9.66, P<0.05) or cardiovascular (odds ratio 3.95, 95% CI: 1.09–14.27, P<0.05) mortality. Receiver operating characteristic curves showed that ERS had the widest significant sensitivity-specificity area under the curve (AUC) predicting all-cause (AUC: 0.855, P<0.05) or cardiovascular mortality (AUC: 0.908, P<0.05).ConclusionERS seems to be a useful noninvasive tool able to stratify the risk of mortality in 1-year follow-up of TAVR patients. These findings, however, require larger trials to be confirmed.

Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion

“…Furthermore, sympathetic over-activity, typical in chronic heart failure, could also play an important role as malignant ventricular arrhythmias’ trigger. In such a context, there are two previous observations corroborating these claims: it was recently confirmed that the sudden cardiac death during AS remains statistically important (Minamino-Muta et al, 2017) and, some non-invasive electrocardiographic (ECG) markers were found significantly associated to a poor outcome in elderly patients with AS after the transcatheter aortic valve replacement (TAVR) (Piccirillo et al, 2018).…”

“…Indeed, in this last part of repolarization phase, I Ks is capable to modulate the QT duration to RR cycle length and, in chronic heart failure, these channels are downregulated. Thus, a mental stress could be sufficient to trigger this alteration also with conventional QT measurement (Aro et al, 2017; Tse et al, 2017; Piccirillo et al, 2018; Yu et al, 2018).…”

Predictive role of Selvester QRS score in patients undergoing transcatheter aortic valve replacement

“…Piccirillo et al 11 analyzed some electrocardiographic criteria to predict events and, among them, LV hypertrophy was correlated with general mortality (AUC, 0.76, p = .015). In our study, patients without hypertrophy, considered no confounders, had a higher mortality rate, despites this finding may look controversial, we believe this may be because these patients did not have an adaptive alteration at high ventricular postload and, therefore, had higher mortality.…”

“…Previous studies have established a correlation between myocardial fibrosis and prognosis in AS 7‐10 . Imbalanced neuro‐autonomic control, ventricular hypertrophy, and the presence of fibrosis were strong predictors of both all‐cause and cardiovascular mortality in a group of elderly patients who underwent TAVR 11 …”

“…[7][8][9][10] Imbalanced neuro-autonomic control, ventricular hypertrophy, and the presence of fibrosis were strong predictors of both all-cause and cardiovascular mortality in a group of elderly patients who underwent TAVR. 11 In the 1970s, Selvester et al 12 correlated the findings of myocardial biopsies with the standard 12-lead electrocardiogram (ECG) and…”