Why the study?
Do ventricular conduction abnormalities predict all-cause mortality in patients with aortic stenosis?
Cohort (n=1,245)
Do ventricular conduction abnormalities predict all-cause mortality in patients with aortic stenosis?
Hazard Ratio: 1.59 (95% CI 1.18–2.13)
p-value: p=0.002
Ventricular conduction disorders, specifically right bundle branch block and prolonged QRS duration, become more prevalent with increasing aortic stenosis severity and are independently associated with increased all-cause mortality.
Ventricular conduction issues may refine AS risk stratification; leaves open whether they merit targeted interventions.
The prevalence and prognostic implications of ventricular conduction disturbances in aortic stenosis (AS) have not been extensively evaluated. The present retrospective study investigated the prevalence and prognostic implications of ventricular conduction abnormalities (including the QRS morphology and duration) in AS. A total of 1,245 patients (mean age 66 ± 14 years, 62.8% men) with varying AS severity (aortic sclerosis 33.9%, mild AS 11.5%, moderate AS 29.9%, and severe AS 24.7%) were evaluated. Demographic, clinical variables, and presence of ventricular conduction abnormalities on the electrocardiogram (based on QRS morphology and duration) were related to occurrence of all-cause mortality, correcting for occurrence of aortic valve replacement. The prevalence of ventricular conduction disorders increased in parallel with AS severity, which was particularly significant for left bundle branch block (4.3% in aortic sclerosis, 2.1% in mild AS, 4.6% in moderate AS, and 8.1% in severe AS; p = 0.042). The QRS duration showed a slight prolongation with increasing AS severity (102 ± 21 ms in aortic valve sclerosis, 99 ± 18 ms in mild AS, 104 ± 22 ms in moderate AS, and 105 ± 22 ms in severe AS; p = 0.044). During a mean follow-up of 8.1 ± 4.8 years, 40.9% of patients died. Right bundle branch block morphology (hazard ratio 1.59, 95% confidence interval 1.18 to 2.13, p = 0.002) and increase of QRS duration (hazard ratio 1.06, 95% confidence interval 1.02 to 1.11; p = 0.006) were independently associated with all-cause mortality. In conclusion, ventricular conduction disorders became more prevalent with increasing severity of AS and have an impact on survival.
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Prihadi et al. (2017) conducted a cohort in Aortic stenosis (n=1,245). Ventricular conduction abnormalities (Right bundle branch block and increased QRS duration) vs. Absence of conduction abnormalities was evaluated on All-cause mortality (HR 1.59, 95% CI 1.18 to 2.13, p=0.002).
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