Key result
High density of the right fibrous trigone assessed by pre-procedure computed tomography is an independent predictor of new-onset conduction disturbance after transcatheter aortic valve implantation (OR 1.01).
Why the study?
Compression of the right fibrous trigone after TAVI may cause conduction disturbance, prompting evaluation of whether pre-procedure CT imaging parameters of this structure predict risk.
Does high density of the right fibrous trigone on pre-procedure CT predict new conduction disturbance in patients undergoing transcatheter aortic valve implantation?
Cohort (n=209)
No
Does high density of the right fibrous trigone on pre-procedure CT predict new conduction disturbance in patients undergoing transcatheter aortic valve implantation?
Odds Ratio: 1.01 (95% CI 1–1.02)
p-value: p=0.003
Pre-procedural computed tomography evaluation of right fibrous trigone density can help predict the risk of new-onset conduction disturbance following transcatheter aortic valve implantation.
RFT imaging parameters may identify post-TAVI conduction risk; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: The right fibrous trigone, which the His bundle penetrates, is part of the subaortic area adjacent to the membranous septum. Structural alterations of the right fibrous trigone may cause conduction disturbance as a result of compression in this area after transcatheter aortic valve implantation. This study analyzed the hypothesis of whether imaging parameters of the RFT could predict the risk of conduction disturbance after transcatheter aortic valve implantation. METHODS: We retrospectively examined 209 patients who underwent transfemoral transcatheter aortic valve implantationat a tertiary cardiac center. The different valve models were divided into 2 groups: self-expanding valve and balloon-expandable valve. Using pre-procedure computed tomography, we evaluated for the alterations of the right fibrous trigone. RESULTS: New conduction disturbance was seen in 75 of 209 (35.8%) patients. Receiver operating characteristics plots displayed a right fibrous trigone density of -6 Hounsfieldunit for SEV and -16 Hounsfield unit for balloon-expandable valve as the optimal cut- off points for prediction conduction disturbance. In multiple regression analyses, the high density of RFT emerged as an independent predictor of conduction disturbance in both the self-expanding valve (odds ratio: 1.01, 95% CI: 1.01 to 1.02, P = 0.035) and bal- loon-expandable valve (odds ratio: 1.01, 95% CI: 1.01 to 1.03, P = 0.017) groups. A shorter membranous septum length and a greater implantation depth were also found to be significantly associated with a higher incidence of conduction disturbance in both trans- catheter aortic valve implantation groups. CONCLUSION: High density of right fibrous trigone is independently associated with con- duction disturbance after transcatheter aortic valve implantation, and its pre-proce- dure computed tomography evaluation can help predict the new-onset of conduction disturbance.
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Aslan et al. (2022) conducted a cohort in Severe symptomatic aortic stenosis (n=209). High density of the right fibrous trigone vs. Low density of the right fibrous trigone was evaluated on New-onset persistent conduction disturbance (composite of left bundle branch block or high-degree AV block) (OR 1.01, 95% CI 1.00-1.02, p=0.003). High density of the right fibrous trigone assessed by pre-procedure computed tomography is an independent predictor of new-onset conduction disturbance after transcatheter aortic valve implantation (OR 1.01).
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