Short membranous septal length (≤6 mm) independently predicted all-cause mortality (HR 3.66; 95% CI 1.52-16.2; p=0.0012) and impaired LVEF recovery after transcatheter aortic valve replacement.
Cohort (n=258)
Does short membranous septal length (≤ 6 mm) predict mortality and adverse outcomes in patients undergoing transfemoral TAVR?
Short membranous septal length (≤ 6 mm) on preprocedural CT is an independent predictor of mortality, heart failure hospitalization, and impaired LVEF recovery after TAVR.
Effect estimate: HR 3.66 (95% CI 1.52-16.2)
p-value: p=0.0012
Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis, although conduction disturbances, especially atrioventricular block and new-onset left bundle branch block (LBBB) remain associated with adverse outcomes. Short membranous septal length (MSL) has been linked to post-TAVR conduction abnormalities, but its prognostic significance is unclear. We retrospectively analyzed 258 patients who underwent transfemoral TAVR. MSL was measured on contrast-enhanced CT, and left ventricular ejection fraction (LVEF) was assessed at baseline, 1 week, and 1 year. The primary endpoint was all-cause mortality; secondary was a composite of mortality or heart failure hospitalization. Patients were classified by MSL ≤ 6 mm or > 6 mm. The short MSL group had higher rates of new-onset LBBB (p = 0.047), mortality (p = 0.046), and the composite endpoint (p = 0.039). MSL ≤ 6 mm independently predicted mortality (HR 3.66, 95% CI 1.52-16.2, p = 0.0012) and the composite outcome (HR 2.56, 95% CI 1.32-6.69, p = 0.0025). LVEF recovery at 1 year was significantly impaired (p = 0.035), and these findings persisted after excluding patients with LBBB or pacemaker implantation. Incorporating MSL ≤ 6 mm into a model with established risk factors improved discrimination for mortality (AUC 0.72 vs 0.67, p = 0.042; cfNRI 0.33). Short MSL was associated with impaired LVEF recovery and adverse outcomes after TAVR. MSL may serve as a simple CT-based marker for preprocedural risk stratification.
Tsurumi et al. (Tue,) conducted a cohort in Severe aortic stenosis (n=258). Short membranous septal length (≤ 6 mm) vs. Membranous septal length > 6 mm was evaluated on All-cause mortality (HR 3.66, 95% CI 1.52-16.2, p=0.0012). Short membranous septal length (≤6 mm) independently predicted all-cause mortality (HR 3.66; 95% CI 1.52-16.2; p=0.0012) and impaired LVEF recovery after transcatheter aortic valve replacement.