Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). In eighty-one elderly patients with AS we calculated several short-period RRand QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRNU) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14–2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40–3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576–0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648–0.954, p < 0.05). In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reductionof thearrhythmicburdenin thissettingofpatients isworthytobe investigated.

Arrhythmic risk in elderly patients candidates to transcatheter aortic valve replacement. predicative role of repolarization temporal dispersion / Piccirillo, Gianfranco; Moscucci, Federica; Fabietti, Marcella; Parrotta, Ilaria; Mastropietri, Fabiola; DI IORIO, Claudia; Sabatino, Teresa; Crapanzano, Davide; Vespignani, Giulia; Mariani, MARCO VALERIO; Salvi, Nicolo'; Magri', Damiano. - In: FRONTIERS IN PHYSIOLOGY. - ISSN 1664-042X. - 10:(2019). [10.3389/fphys.2019.00991]

Arrhythmic risk in elderly patients candidates to transcatheter aortic valve replacement. predicative role of repolarization temporal dispersion

Gianfranco Piccirillo
Primo
Conceptualization
;
Federica Moscucci
Secondo
Membro del Collaboration Group
;
Marcella Fabietti
Membro del Collaboration Group
;
Ilaria Parrotta
Membro del Collaboration Group
;
Fabiola Mastropietri
Membro del Collaboration Group
;
Claudia Di Iorio
Membro del Collaboration Group
;
Sabatino, Teresa
Membro del Collaboration Group
;
Crapanzano, Davide
Membro del Collaboration Group
;
VESPIGNANI, GIULIA
Membro del Collaboration Group
;
Marco valerio Mariani
Membro del Collaboration Group
;
Nicolò Salvi
Membro del Collaboration Group
;
Damiano Magrì
Ultimo
Membro del Collaboration Group
2019

Abstract

Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). In eighty-one elderly patients with AS we calculated several short-period RRand QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRNU) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14–2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40–3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576–0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648–0.954, p < 0.05). In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reductionof thearrhythmicburdenin thissettingofpatients isworthytobe investigated.
2019
aortic stenosis; TAVR; QT; QT standard deviation; T peak-T end, QTc; QT variability
01 Pubblicazione su rivista::01a Articolo in rivista
Arrhythmic risk in elderly patients candidates to transcatheter aortic valve replacement. predicative role of repolarization temporal dispersion / Piccirillo, Gianfranco; Moscucci, Federica; Fabietti, Marcella; Parrotta, Ilaria; Mastropietri, Fabiola; DI IORIO, Claudia; Sabatino, Teresa; Crapanzano, Davide; Vespignani, Giulia; Mariani, MARCO VALERIO; Salvi, Nicolo'; Magri', Damiano. - In: FRONTIERS IN PHYSIOLOGY. - ISSN 1664-042X. - 10:(2019). [10.3389/fphys.2019.00991]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1305908
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