Abstract
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.
Highlights
Of patients with aortic stenosis (AS).[3,4] the present study aimed at investigating the prevalence of ventricular conduction disorders in a large registry of patients with AS and the prognostic relevance of QRS morphology and duration in this population
When analyzing the prognostic effect of QRS duration, we found that patients with QRS duration ≥130 ms showed significantly worse survival than did patients with QRS duration
The prevalence of ventricular conduction disorders, LBBB QRS morphology, increased along with the severity of AS. Both QRS duration and morphology were independently associated with all-cause mortality in patients with AS
Summary
Mara Vollema, MDa, Arnold C.T. Ng, MD, PhDa,c, Nina Ajmone Marsan, MD, PhDa, Jeroen J. Aortic valve stenosis (AS), one of the most common valvular diseases in developed countries, is a progressive process of valve calcification and inflammation, which can affect the conduction system directly through calcification and indirectly through increased pressure afterload on the left ventricle (LV).[1] In patients with severe AS, ventricular conduction disorders (left [LBBB] and right [RBBB] bundle branch block or nonspecific intraventricular conduction delay [IVCD]) are reported to be more prevalent than in the general population.[2] the factors influencing the increased prevalence of ventricular conduction disorders (QRS morphology and duration) are poorly understood and have not been evaluated in a large cohort of patients with varying grades of AS. Of patients with AS.[3,4] the present study aimed at investigating the prevalence of ventricular conduction disorders in a large registry of patients with AS and the prognostic relevance of QRS morphology and duration in this population
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