Abstract
Background
No data exist on the clinical and prognostic significance of syncope in patients undergoing
transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Methods
A total of 1705 consecutive patients with severe aortic stenosis undergoing TAVR in
a tertiary university centre between 2007 and 2021 were included and classified according
to the presence of syncope before the TAVR procedure. Baseline, procedural, and follow-up
data were collected prospectively in a dedicated database.
Results
A total of 115 patients (7%) presented with syncope before the TAVR procedure. Of
these, 15 patients (13%) showed arrhythmic episodes as the probable cause of the syncope,
and all of them had pacemakers implanted at a median of 13 (6 to 53) days before the
TAVR procedure. Patients with syncope were older (82 ± 8 years vs 80 ± 8 years, P = 0.001) and had a higher rate of pacemaker implantation before the TAVR procedure
(27% vs 14%, P < 0.001), with no differences between groups regarding the severity of aortic stenosis
(transvalvular gradient, valve area). There were no differences between groups in
30-day (adjusted hazard ratio [HR], 1.28; 95% confidence interval [CI], 0.46-3.60)
and 1-year (adjusted HR, 0.71; 95% CI, 0.0.35-1.45) mortality following TAVR.
Conclusions
Syncope was not associated with a more advanced valvular disease and had no significant
prognostic impact on patients undergoing TAVR. However, arrhythmias and conduction-system
disturbances were more common in patients with previous syncope and might play a relevant
role in the pathogenesis of syncope in patients with aortic stenosis.
Résumé
Contexte
On ne dispose d’aucune donnée sur l’importance clinique et pronostique des syncopes
chez les patients qui subissent un remplacement valvulaire aortique par cathéter (RVAC)
en raison d’une sténose aortique sévère.
Méthodologie
En tout, 1 705 patients consécutifs atteints de sténose aortique sévère ayant subi
un RVAC dans un centre universitaire de soins tertiaires entre 2007 et 2021 ont été
inclus dans l’analyse et classés en fonction de la survenue d’une syncope avant le
RVAC. Les données relatives aux caractéristiques initiales et au suivi ont été recueillies
de façon prospective dans une base de données spécialisée.
Résultats
Au total, 115 patients (7 %) ont présenté une syncope avant leur RVAC. Chez 15 de
ces patients (13 %), des épisodes d’arythmies étaient la cause probable de la syncope,
et tous les sujets s’étaient fait implanter un stimulateur cardiaque à une médiane
de 13 jours (de 6 à 53) avant le RVAC. Les patients présentant une syncope étaient
plus âgés (82 ± 8 ans c. 80 ± 8 ans, p = 0,001) et affichaient un taux d’implantation d’un stimulateur cardiaque plus élevé
avant le RVAC (27 % c. 14 %, p < 0,001). On n’a observé aucune différence entre les groupes en ce qui a trait à
la gravité de la sténose aortique (gradient transvalvulaire, surface valvulaire).
Par ailleurs, après le RVAC, aucune différence n’a été observée entre les groupes
pour ce qui est de la mortalité à 30 jours (rapport des risques instantanés [RRI corrigé]
: 1.28; intervalle de confiance [IC] à 95 % : 0,46-3,60) et à 1 an (RRI corrigé :
0,71; IC à 95 % : 0,35-1,45).
Conclusions
La syncope n’a pas été associée à une valvulopathie plus avancée et n’a pas eu d’effet
significatif sur le pronostic des patients ayant subi un RVAC. Toutefois, les arythmies
et les troubles du système de conduction cardiaque étaient plus fréquents chez les
patients ayant des antécédents de syncope, et ces phénomènes pourraient jouer un rôle
notable dans la pathogenèse de la syncope chez les patients atteints de sténose aortique.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: February 18, 2023
Accepted:
February 13,
2023
Received:
December 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See page 7 for disclosure information.
Identification
Copyright
© 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Reply to Francisco-Pascual and Rivas-Gándara—Syncope in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve ReplacementCanadian Journal of Cardiology
- PreviewWe appreciate Drs Francisco-Pascual and Rivas-Gándara’s interest in our work,1 and we thank them for their enriching comments.2 The authors point out the marked difference between their previous experience,3 in which a direct relation between syncope and aortic stenosis (AS) was found in only 18% of patients compared with the 87% in our population. The different definitions of AS-related syncope would be the main reason for such disparity; whereas in their population exercise-induced low cardiac output was required to call for certain or highly probable AS-related syncope, in our cohort, all patients in whom arrhythmic events leading to syncope were not identified were classified as such.
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- Preview
- Syncope in Patients With Aortic Stenosis: Does Investigating the Cause Affect Prognosis?Canadian Journal of Cardiology
- PreviewWe read with great interest the recently published article by Keller et al., "Syncope in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement,” in the Canadian Journal of Cardiology.1 First of all, we congratulate the authors for their contribution to the understanding of the role of aortic stenosis in the etiology of syncope.
- Full-Text
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