RESUMEN
(1) Background: Conduction disturbance requiring a new permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) has traditionally been a common complication. New implantation techniques with self-expanding platforms have reportedly reduced the incidence of PPM. We sought to investigate the predictors of PPM at 30 days after TAVI using Evolut R/PRO/PRO+; (2) Methods: Consecutive patients who underwent TAVI with the Evolut platform between October 2019 and August 2022 at University Hospital Galway, Ireland, were included. Patients who had a prior PPM (n = 10), valve-in-valve procedures (n = 8) or received >1 valve during the index procedure (n = 3) were excluded. Baseline clinical, electrocardiographic (ECG), echocardiographic and multislice computed tomography (MSCT) parameters were analyzed. Pre-TAVI MSCT analysis included membranous septum (MS) length, a semi-quantitative calcification analysis of the aortic valve leaflets, left ventricular outflow tract, and mitral annulus. Furthermore, the implantation depth (ID) was measured from the final aortography. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal MS and ID cutoff values to predict new PPM requirements, respectively; (3) Results: A total of 129 TAVI patients were included (age = 81.3 ± 5.3 years; 36% female; median EuroSCORE II 3.2 [2.0, 5.4]). Fifteen patients (11.6%) required PPM after 30 days. The patients requiring new PPM at 30 days were more likely to have a lower European System for Cardiac Operative Risk Evaluation II, increased prevalence of right bundle branch block (RBBB) at baseline ECG, have a higher mitral annular calcification severity and have a shorter MS on preprocedural MSCT analysis, and have a ID, as shown on the final aortogram. From the multivariate analysis, pre-TAVI RBBB, MS length, and ID were shown to be predictors of new PPM. An MS length of <2.85 mm (AUC = 0.85, 95%CI: (0.77, 0.93)) and ID of >3.99 mm (area under the curve (AUC) = 0.79, (95% confidence interval (CI): (0.68, 0.90)) were found to be the optimal cut-offs for predicting new PPM requirements; (4) Conclusions: Membranous septum length and implantation depth were found to be independent predictors of new PPM post-TAVI with the Evolut platform. Patient-specific implantation depth could be used to mitigate the requirement for new PPM.
RESUMEN
BACKGROUND: Self report questions are often used in population studies to assess sensory efficacy and decline. These questions differ in their validity in assessing sensory impairment depending on the wording of the question and the characteristics of the population. We tested the validity of the self-report questions on hearing efficacy (self reported hearing, ability in following a conversation, use of a telephone and use of hearing aids) used in The Irish Longitudinal Study on Ageing (TILDA). METHODS: We tested sensitivity and specificity, positive and negative predictive values of each question against the Whispered Voice Test, a relatively easy to administer and cost effective alternative to the standard audiometric test. RESULTS: In this population the question 'Is your hearing (with or without a hearing appliance)/ Excellent/Very Good/Good/Fair/Poor?' showed the best diagnostic value in relation to the other questions (sensitivity 55.56% and specificity 94.67%). The question 'Can you use a normal telephone?' was deemed ineffective because of a very poor sensitivity (5.56%) and was proposed for exclusion from subsequent waves of TILDA. CONCLUSIONS: We showed that this validity check was useful to select the questions that most effectively assess hearing deficits and provided crucial information for the subsequent waves. We argue that longitudinal studies using self-reports of sensory efficacy would benefit from a similar check.