刘家乐,陈泽伟,易岩峰,唐一瑞,方臻飞

• 1:中南大学湘雅二医院心血管内科

摘要(Abstract)：

目的 探究经导管主动脉瓣置换术（TAVR）后新发传导阻滞（NOCD）的相关因素，建立预测模型对传导阻滞发生风险进行评估。方法 纳入2016年1月至2022年3月中南大学湘雅二医院行TAVR的症状性重度主动脉瓣狭窄或重度主动脉瓣反流的184例患者，通过医院信息系统和影像数据库收集患者的人口学、病史、检查结果、影像图像等临床数据，测量人工瓣膜置入深度等传导阻滞相关数据，由专科医师对心电图、超声心动图、CT血管造影（CTA）、手术资料等进行数据的提取和分析。使用SPSS软件对数据进行统计学分析，构建NOCD的多因素Logistic回归预测模型。结果 以TAVR术后NOCD作为结局事件，184例患者分为NOCD组（57例）和非NOCD组（127例）。TAVR术后NOCD发生率为31.0%，单纯重度主动脉瓣反流患者TAVR术后NOCD发生率为63.6%(7/11)。NOCD组较非NOCD组的主动脉角度更大[（57.7±10.3）°比（52.0±9.0）°，P<0.001]、锚定区尺寸比更大[（129±28）%比（120±21）%,P=0.018]、人工瓣膜置入位置更深[（7.2±5.1）mm比（4.8±4.2）mm,P=0.001]，并且单纯重度主动脉瓣反流患者比例更高[12.3%比3.1%,P=0.037]，差异均有统计学意义。通过多因素Logistic回归分析显示主动脉角度>54.5°（OR 3.78,95%CI 1.86～7.63,P<0.001）和人工瓣膜置入深度>5.7 mm(OR 3.39,95%CI 1.68～6.85,P<0.001)是TAVR术后NOCD的独立危险因素，并建立了以主动脉角度>54.5°、人工瓣膜置入深度>5.7 mm和锚定区尺寸比>122.9%为变量的预测模型。受试者工作特征曲线下面积（AUC）0.709(95%CI 0.623～0.795)，可预测TAVR术后NOCD。结论 主动脉角度>54.5°和人工瓣膜置入深度>5.7 mm是TAVR术后NOCD的独立危险因素。

关键词(KeyWords)： 经导管主动脉瓣置换术;传导阻滞;危险因素;预测模型

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘家乐,陈泽伟,易岩峰,唐一瑞,方臻飞

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