经导管主动脉瓣置换术术后永久起搏器植入的预测因素Meta分析  

Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement:a Meta-analysis

作　　者：李瑞锋 韩克[1] 张勇[1] 王小可 吴岳[1] 袁祖贻[1] LI Rui-feng;HAN Ke;ZHANG Yong;WANG Xiao-ke;WU Yue;YUAN Zu-yi(Department of Cardiovascular Medicine,the First Affi liated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061

出　　处：《中国介入心脏病学杂志》2021年第11期624-633,共10页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划(2019YFA0802300);国家自然科学基金项目(81822005、81970351)。

摘　　要：目的旨在系统性识别和总结经导管主动脉瓣置换术(TAVR)术后永久起搏器植入(PPI)的预测因素。方法对探讨TAVR术后PPI预测因素的研究进行系统检索,提取研究数据、患者特征、心电图特征、影像学特征及手术相关指标,分析总体及不同类型瓣膜TAVR术后PPI的比例,计算各预测因素的比值比(OR)和95%置信区间(CI),并进一步根据瓣膜类型进行分层分析,分别计算使用自膨胀瓣膜及球囊扩张瓣膜行TAVR术后PPI预测因素的OR和95%CI。结果最终纳入30项研究的数据,包含23934例患者,其中PPI占比11.8%,自膨胀瓣膜PPI风险为25.9%,球囊扩张瓣膜术后PPI风险为7.5%。综合分析显示,完全性右束支传导阻滞(RBBB)(OR 5.39,95%CI4.73~6.14,P<0.001)、自膨胀瓣膜较球囊扩张瓣膜(OR3.86,95%CI3.38~4.40,P<0.001)与TAVR术PPI风险显著相关,一度房室传导阻滞(一度AVB)(OR 1.86,95%CI 1.54~2.24,P<0.001)、男性较女性(OR 1.17,95%CI 1.07~1.28,P<0.001)、PR间期较长(MD 12.13,95%CI 8.09~16.18,P<0.001)、QRS波较宽(MD 6.59,95%CI 5.40~7.77,P<0.001)、置入深度较深(MD 1.29,95%CI 0.99~1.58,P<0.001)与TAVR术后PPI风险相关。分层分析表明,使用自膨胀瓣膜:RBBB(OR5.53,95%CI3.37~8.11,P<0.001)、置入深度更深(MD1.60,95%CI 1.20~2.01,P<0.001)与TAVR术后PPI风险相关;使用球囊扩张瓣膜:RBBB(OR 7.08,95%CI 5.46~9.18,P<0.001)、一度AVB(OR 1.71,95%CI 1.38~2.12,P<0.001)、QRS波较宽(MD 15.45,95%CI 12.26~18.65,P<0.001)与TAVR术后PPI风险相关。结论TAVR术后PPI的比例为11.8%。RBBB、瓣膜类型、一度AVB、性别、基础PR间期、QRS波宽度及瓣膜置入深度可作为TAVR术后PPI的预测因素。Objective The purpose of this study was to systemically identify and conclude the predictors of PPI after TAVR.Methods We conducted a meta-analysis,searching for studies about the predictors of PPI after TAVR,data of patient characteristics,ECG characteristics,imaging characteristics and surgical related indicators were extracted and analyzed.The postoperative PPI proportion of overall and different types of valves with the odds ratio(OR)and 95%confidence interval(CI)of each predictor were also analyzed.Besides,based on the type of valve,we further stratified the OR and 95%CI of the predictors of the self-expandable valve and balloon-expandable valve,respectively.Results We finally filtered data from 30 studies,including 23934 patients who treated with TAVR,with a PPI rate of 11.8%.The PPI rate was 25.9%and 7.5%among self-expandable valve and balloon-expandable valve,respectively.Comprehensive analysis showed that complete right bundle branch block(RBBB)(OR 5.39,95%CI 4.73–6.14,P<0.001)and valve type(OR 3.86,95%CI 3.38–4.40,P<0.001)are significantly associated with higher PPI risk after TAVR,and first-degree atrioventricular block(AVB)(OR 1.86,95%CI 1.54–2.24,P<0.001),gender(OR 1.17,95%CI 1.07–1.28,P<0.001),PR interval(MD 12.13,95%CI8.09–16.18,P<0.001),QRS width(MD 6.59,95%CI 5.40–7.77,P<0.001),and implantation depth(MD 1.29,95%CI 0.99–1.58,P<0.001)were also associated with PPI risk after TAVR.Stratified analysis showed that when using self-expanding valve,RBBB(OR 5.53,95%CI 3.37–8.11,P<0.001)and depth of implantation(MD 1.60,95%CI 1.20–2.01,P<0.001)were associated with PPI risk after TAVR.While when using balloon expandable valve,RBBB(OR 7.08,95%CI 5.46–9.18,P<0.001),first-degree AVB(OR 1.71,95%CI 1.38–2.12,P<0.001)and QRS width(MD 15.45,95%CI 12.26–18.65,P<0.001)were associated with PPI risk after TAVR.Conclusions The average ratio of PPI after TAVR was 11.8%.RBBB,valve type,firstdegree AVB,gender,baseline PR interval,QRS width and depth of implantation could be used as predictors of PPI

关 键 词：经导管主动脉瓣置换术 永久起搏器植入 预测因子 

分 类 号：R543.1[医药卫生—心血管疾病]