Prognostic Value of QRS Duration After Transcatheter Aortic Valve Implantation for Aortic Stenosis Using the CoreValve

Transcatheter aortic valve implantation (TAVI) is effective in treating severe aortic stenosis in high-risk surgical patients. We evaluated the value of the QRS duration (QRSd) in predicting the mid-term morbidity and mortality after TAVI. We conducted a prospective cohort study of 91 consecutive patients who underwent TAVI using the Core Valve at our teaching hospital cardiology unit in 2008 to 2010 who survived to hospital discharge; 57% were women, and their mean age was 84 +/- 7 years. The QRSd at discharge was used to classify the patients into 3 groups: QRSd <= 120 ms, n = 18 (20%); QRSd > 120 ms but <= 150 ms, n = 30 (33%); and QRSd > 150 ms, n = 43 (47%). We used 2 end points: (1) all-cause mortality and (2) all-cause mortality or admission for heart failure. After a median of 12 months, the normal-QRSd patients showed a trend toward, or had, significantly better overall survival and survival free of admission for heart failure compared with the intermediate-QRSd group (p = 0.084 and p = 0.002, respectively) and the long-QRSd group (p = 0.015 and p = 0.001, respectively). The factors significantly associated with all-cause mortality were the Society of Thoracic Surgeons score, aortic valve area, post-TAVI dilation, acute kidney injury, hospital days after TAVI, and QRSd at discharge. On multivariate analysis, QRSd was the strongest independent predictor of all-cause mortality (hazard ratio 1.036, 95% confidence interval 1.016 to 1.056; p < 0.001) and all-cause mortality or heart failure admission (hazard ratio 1.025, 95% confidence interval 1.011 to 1.039; p < 0.001). The other independent predictors were the Society of Thoracic Surgeons score, acute kidney injury, and post-TAVI hospital days. In conclusion, a longer QRSd after TAVI was associated with greater morbidity and mortality after 12 months. The QRSd at discharge independently predicted mortality and morbidity after TAVI. (C) 2013 Elsevier Inc. All rights reserved.