Possible predictive role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients: preliminary data

Figures & data

Table 1 General characteristics of the transcatheter aortic valve replacement patients

Analyzed data	N: 40
Age, years	81±7
M/F	23/17
BMI, kg/m^2	26±4
SBP, mmHg	135±13
DBP, mmHg	84±56
Atrial fibrillation	25 (63)
Complete left bundle branch block	15 (38)
NYHA class III	38 (95)
NYHA class IV	2 (5)
Aortic peak gradient, mmHg	82±20
Aortic mean gradient, mmHg	52±13
Ejection fraction, %	48±10
Stroke volume index, mL/m^2	31±6
Cardiac index, L/m^2	2.05±0.36
Peripheral resistance, units	2,168±639
Left ventricular mass index, g/m^2	141±31
Mini-mental state evaluation	26±3
Cumulative illness rating scale	12±4
Activity of day living	5±1
Instrumental activities of day living	5±2
Clinical frailty scale	4±1
Mini-nutritional assessment	23±4
Short form health survey
– Vitality	45±14
– Physical functioning	21±19
– Body pain	58±29
– General heath perceptions	44±17
– Physical role functioning	14±31
– Emotional role functioning	38±46
– Social role function	45±18
– Mental health	58±15
β-blockers, n (%)	35 (88)
Furosemide, n (%)	24 (60)
Calcium channel blockers, n (%)	16 (40)
ACE/sartan, n (%)	13 (63)
Amiodarone, n (%)	2 (5)
Anticoagulants, n (%)	25 (63)
Valve type
• CoreValve, n (%)	2 (5%)
• EdwardsXT, n (%)	1 (2.5%)
• Edwards Sapien 3, n (%)	19 (47.5%)
• CoreValveEvolut R, n (%)	12 (30%)
• Direct Flow, n (%)	5 (12.5%)
• Lotus, n (%)	2 (5%)

Note: Data are expressed as mean ± SD or number (n) of patients (%).

Abbreviations: ACE, angiotensin-converting enzyme; BMI, body mass index; DBP, diastolic blood pressure; M/F, male/female; NYHA, New York Heart Association; SBP, systolic blood pressure.

Figure 1 Comparison between survivors and cardiovascular mortality cases regarding the significant ECG data, obtained baseline.

Notes: In particular, the survivor subjects after 1 year of TAVR follow-up showed lower pre-TAVR: Tpeak–Tend segment, QRS transition zone, QRS-T angle, ECG left ventricular hypertrophy, and ERS. In the box plots, the central line represents the median distribution. Each box spans from 25th to 75th percentile points, and error bars extended from 10th to 90th percentile points.
Abbreviations: ECG, electrocardiogram; ERS, electrical risk score; TAVR, transcatheter aortic valve replacement; V4, 4th precordial lead.

Table 2 Electrocardiographic measures in the transcatheter aortic valve replacement patients

Analyzed data	N: 40
Heart rate, bpm	74±13
QRS, ms	115±25
QTC, ms	460±46
JTC, ms	334±44
Tpeak–Tend, ms	94±20
QRS-T angle, °	−60 (118)
QRS transition zone	4±1
Electrocardiographic left ventricular hypertrophy, mV	3.4±1.4
Electrical risk score	3.9±1.9

Note: Data are expressed as mean ± SD or median (interquartile range).

Table 3 Electrocardiographic abnormal markers in the transcatheter aortic valve replacement patients

Analyzed data	N: 40
Heart rate >75	15 (38)
QRS >110 ms	20 (50)
QTBazett >450 or >460 ms or JTBazett >330 or >340 ms	21 (53)
Tpeak–Tend >89 ms	23 (58)
QRS-T angle >90°	12 (30)
QRS transition zone ≥ V4	15 (38)
Electrocardiographic left ventricular hypertrophy	10 (25)
Electrical risk score ≥4	5 (13)

Notes: Data are presented as cases (%), QTc >450 ms in men and >460 ms in women; JT_Bazett >330 in men or >340 ms in women.

Abbreviation: V4, 4th precordial lead.

Figure 2 Comparison between survivors and total mortality cases regarding the significant ECG data, obtained baseline.

Notes: In particular, the survivor subjects after 1 year of TAVR follow-up showed a significant lower pre-TAVR: Tpeak–Tend segment, QRS transition zone, electrocardiogram left ventricular hypertrophy, and ERS. In the box plots, the central line represents the median distribution. Each box spans from 25 to 75th percentile points, and error bars extended from 10 to 90th percentile points.

Abbreviations: ECG, electrocardiogram; ERS, electrical risk score; TAVR, transcatheter aortic valve replacement.

Figure 3 We reported the total (A) and cardiovascular (B) mortality in the subjects with less or equal or higher than four electrical risk score in the study subjects.

Notes: In the B study population, we excluded the subject deceased for non-CVD. Statistical comparison was obtained by chi-squared test.

Figure 4 Receiver operating characteristic curve (ROC) analysis showing that the electrical risk score (ERS) was the best predictor of total (A) or cardiovascular (B) mortality in TAVR patients.

Abbreviations: sig, significance; std, standard; TAVR, transcatheter aortic valve replacement.

Figure 5 Odds ratio for electrical risk score, electrocardiographic left ventricular hypertrophy (ECG LVH), QRS transition zone > V4, Tpeak–Tend interval, ejection fraction in respect to total and cardiovascular mortality in uni- or multivariable analysis.

Abbreviation: V4, 4th precordial lead.