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      Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis

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          Abstract

          Background

          QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis.

          Methods

          Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6 th month after TAVI, computed QTd and left ventricular mass index (LVMI).

          Results

          A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm 2). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6 th month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m 2 vs. 184 ± 40 g/m 2, P = 0.04, respectively). There was a significant correlation between QTd and LVMI ( r = 0.646, P < 0.001).

          Conclusions

          QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis.

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          Most cited references20

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          Spontaneous course of aortic valve disease.

          O Hess, J Turina, H P Krayenbuehl … (1987)
          The fate of patients with aortic valve disease of varying degrees of severity and the relationship between symptoms and haemodynamic status have been studied in 190 adults undergoing cardiac catheterization during the last two decades. During the follow-up period, 41 patients died and 86 underwent aortic valve replacement; these two events were the endpoints for the calculation of 'event-free' cumulative survival. First-year survival in haemodynamically severe disease was 60% in aortic stenosis and 96% in aortic regurgitation; in moderate and mild disease (in the absence of coronary artery disease) first-year survival was 100% in both groups. After 10 years, 9% of those with haemodynamically severe aortic stenosis and 17% of those with severe regurgitation were event-free, in contrast to 35% and 22%, respectively, of those with moderate changes and 85% and 75%, respectively, of those with mild abnormalities. In the presence of haemodynamically severe disease, 66% of the patients with stenosis and 14% of those with regurgitation were severely symptomatic (history of heart failure, syncope or New York Heart Association class III and IV); 23% of patients with moderate stenosis and 14% with moderate regurgitation were also severely symptomatic. Only 40% of those with disease that was severe both haemodynamically and symptomatically with either stenosis or regurgitation survived the first two years; only 12% in the stenosis group and none in the regurgitation group were event-free at 5 years. Patients with haemodynamically severe aortic stenosis who had few or no symptoms had a 100% survival at 2 years; the comparable figure for the aortic regurgitation group was 94%; 75% of the patients in the stenosis group and 65% in the regurgitation group were event-free at 5 years. In the moderate or mild stenosis and regurgitation groups there was no mortality within the first 2 years in the absence of coronary artery disease, regardless of symptomatic status. Haemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with haemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without a significant risk of sudden death. In severe aortic regurgitation, the decision for surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of risk of sudden death. In the absence of coronary artery disease, moderate aortic valve disease does not require valve operation for prognostic reasons.
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            Measurement of the QT interval and the risk associated with QTc interval prolongation: a review.

            Melissa A. Moss (1993)
            The accurate measurement of the QT interval and its correction or adjustment for cycle length, age, and gender have been topics of increasing interest over the course of the past 70 years. The availability of digitized electrocardiographic recordings on large normal populations together with statistical adjustment for pertinent covariates has provided useful data for defining QT interval prolongation. Data from the International Long QT Syndrome Registry indicate that the probabilistic risk of developing malignant arrhythmias in patients with QT prolongation is exponentially related to the length of the QTc interval. The risk is further accentuated by the development of T-wave alternans, particularly at very prolonged QTc intervals.
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              Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study.

              P M Okin, R Devereux, B V Howard … (2000)
              Both a prolonged QT interval and increased QT interval dispersion (QTD) have been proposed as surface ECG markers of vulnerability to ventricular arrhythmias and potential predictors of mortality. The predictive values of QT prolongation and QTD were assessed in 1839 participants in the Strong Heart Study, a prospective study of cardiovascular disease in American Indians. ECGs were acquired at 250 Hz; QT intervals were measured by computer in all 12 leads and corrected for heart rate (QTc) by use of Bazett's formula. QTD was calculated as the difference between the maximum and minimum QTc. After a mean follow-up of 3.7+/-0.9 years, there were 188 deaths from all causes, including 55 cardiovascular deaths. In univariate Cox analyses, prolonged QTc and increased QTD were significant predictors of all-cause mortality (chi(2)=53.0, P<0.0001; chi(2)=11.3, P=0.0008) and cardiovascular mortality (chi(2)=14.7, P=0.0001; chi(2)=26.5, P<0.0001). In multivariate Cox regression analyses controlling for risk factors, QTc remained a strong predictor of all-cause mortality (chi(2)=16.5, P<0.0001) and a weaker predictor of cardiovascular mortality (chi(2)=5.8, P=0.016); QTD remained a significant predictor of cardiovascular mortality only (chi(2)=12.5, P=0.0004). These findings support the value of computerized measurements of QTc and QTD in noninvasive risk stratification and suggest that these surface ECG variables may reflect different underlying abnormalities of ventricular repolarization.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Geriatr Cardiol
                Journal ID (iso-abbrev): J Geriatr Cardiol
                Journal ID (publisher-id): JGC
                Title: Journal of Geriatric Cardiology : JGC
                Publisher: Science Press
                ISSN (Print): 1671-5411
                Publication date (Print): December 2014
                Volume: 11
                Issue: 4
                Pages: 286-290
                Affiliations
                [1 ]Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Çamlık Street, Trabzon 61040, Turkey
                [2 ]Department of Cardiology, Kafkas University Hospital, Kars, Turkey
                Author notes
                Correspondence to: Hakan Erkan, MD, Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Çamlık Street, Trabzon 61040, Turkey. E-mail: drhakanerkan@ 123456hotmail.com Telephone:+ 9-462-2311907 Fax:+9-462-2310483
                Article
                Publisher ID: jgc-11-04-286
                DOI: 10.11909/j.issn.1671-5411.2014.04.002
                PMC ID: 4294144
                PubMed ID: 25593576
                SO-VID: e4e206f1-edbe-465d-bf97-9f3e35d7c539
                Copyright © Institute of Geriatric Cardiology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.

                History
                Date received : 27 June 2014
                Date revision received : 26 August 2014
                Date accepted : 22 September 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: aortic stenosis,qt dispersion,transcatheter aortic valve implantation
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: aortic stenosis, qt dispersion, transcatheter aortic valve implantation

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