Early Reversal of Cardiac Remodelling in Patients with New-onset Persistent Left Bundle Branch Block after Transcatheter Aortic Valve Replacement

Early Reversal of Cardiac Remodelling in Patients with New-onset Persistent Left Bundle Branch Block after Transcatheter Aortic Valve Replacement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early Reversal of Cardiac Remodelling in Patients with New-onset Persistent Left Bundle Branch Block after Transcatheter Aortic Valve Replacement Shuzhen Wang, Kunyue Tan, Xiaoqiang Gao, Lijuan Zhang, Chunxia Liu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6855714/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 16 You are reading this latest preprint version Abstract OBJECTIVE New-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR) is an independent predictor of long-term cardiovascular mortality in patients. The aim of this study is to evaluate the impact of new-onset LBBB on early cardiac reverse remodelling and clinical outcomes after TAVR. METHODS A retrospective analysis was performed on 101 patients who underwent successful TAVR for severe aortic stenosis between March 2021 and October 2024 at our institution. Echocardiographic variables indicative of cardiac remodelling were analysed preoperatively and at one and six months after TAVR. Furthermore, the clinical outcomes of the patients were monitored during the follow-up period. RESULT Of the 101 patients who underwent TAVR, 28 (27.7%) had new-onset LBBB. Prosthetic valve implantation depth and serum low-density lipoprotein cholesterol levels were influential factors of new LBBB, which was more prevalent in patients with thinner interventricular septal thickness preoperatively. At the six-month follow-up, new-LBBB group showed an increase in left ventricular diameter and left ventricular mass index and a reduction in left ventricular ejection fraction compared with the preoperative period. Mitral regurgitation in no-LBBB group was significantly reduced at 1 month postoperatively and remained stable by six months. In contrast, mitral regurgitation in new-LBBB group was reduced at one month postoperatively, but worsened at six months.There was no significant difference in rehospitalization within 6 months postoperatively between patients with or without LBBB. CONCLUSIONS New-onset persistent LBBB after TAVR did not affect short-term rehospitalization, but may adversely affect early postoperative reversal of cardiac remodelling. New-onset left bundle branch block Transcatheter aortic valve replacement Echocardiography Cardiac Remodelling Figures Figure 1 Figure 2 Introduction Transcatheter aortic valve replacement (TAVR) has been demonstrated to be a safe and feasible alternative to surgery for patients suffering from symptomatic severe aortic stenosis(AS). Advancements in technology and increasing experience with implementation have significantly reduced the incidence of complications such as severe perivalvular regurgitation and perioperative mortality. However, cardiac conduction disturbances remain a common complication after TAVR, with left bundle branch block(LBBB) being the most prevalent, with a prevalence of 4%-65%[ 1 , 2 ]. There are fewer data on reversal of cardiac structural and functional remodelling in patients with new-onset LBBB after TAVR. In this study, the effect of new-onset LBBB on early reverse cardiac structural and functional remodelling in patients after TAVR by echocardiography was analysed. Furthermore, the impact of new-onset LBBB on the short-term rehospitalization of patients was observed. Materials and methods A total of 116 patients with severe AS who underwent successful transfemoral TAVR at our institution between March 2021 and October 2024, all with self-expanding valves, were included. Inclusion criteria were patients with severe AS who had been successfully treated with transfemoral TAVR and were older than 61 years old, with the following diagnostic criteria for severe AS: the effective aortic orifice area 4m/s and mean transvalvular pressure gradient ≥ 40mmHg measured by transthoracic echocardiography[ 3 ]. Exclusion criteria included patients with a history of LBBB or pacemaker implantation, and those who developed a high degree of perioperative atrioventricular block or had a reversal of LBBB during follow-up. According to these inclusion and exclusion criteria, 3 patients with a history of pacemaker implantation, 7 patients who developed a high degree of perioperative atrioventricular block (5 of whom had pacemakers implanted), and 5 cases of LBBB reversal within 1 month were excluded from this study, and 101 patients were finally included. New-onset persistent LBBB was defined as LBBB that was not present at baseline but was present on the electrocardiogram(ECG) at discharge(QRS duration > 120 ms, delayed onset of intrinsic deflection in leads V5 and V6, broad monophasic R waves that are usually notched in leads I, V5 and V6, and secondary ST- and T-wave changes in the opposite direction to the main QRS deflection)[ 4 ]. The new-LBBB group (28 cases) and the no-LBBB group (73 cases) were categorised according to the presence or absence of new-onset persistent LBBB. General clinical characteristics of the patients were collected, including sex, age, past history, laboratory tests and rehospitalization. All patients underwent transthoracic echocardiography 1–3 days preoperatively and at 1 month and 6 months postoperatively using an EPIQ 7C instrument with an S5−1 probe. The structural parameters measured by echocardiography mainly include cardiac chamber diameter, ventricular wall thickness and aortic valve annulus diameter, as well as calculation of left ventricular mass index. Biplane method was used to measure left ventricular ejection fraction(LVEF). Doppler echocardiography was used to assess hemodynamic parameters, such as peak aortic valve velocity and mean transaortic pressure gradient, to observe valve activity and to grade the degree of mitral regurgitation, which was categorized into four grades: no/trace, mild, moderate and severe[ 5 ]. Increased or decreased mitral regurgitation was defined as an increase or decrease in the degree of regurgitation by at least one grade or more compared with the previous examination. Perivalvular regurgitation was classified as mild, moderate, or severe according to the ratio of the perivalvular regurgitant bundle to the circumference of the aortic annulus in short-axis views of the aorta[ 6 ]. Statistical analysis Statistical analysis was performed using SPSS Statistics version 26.0 (SPSS, Inc., Chicago, IL).Continuous variables were tested for normal distribution and chi-squared. Those satisfying both conditions were presented as mean ± standard deviation, and intergroup comparisons were performed using independent samples t-tests. Intragroup comparisons before and after surgery were analysed using F-tests, with multiple comparisons conducted using LSD t-tests. For data that did not meet the assumptions of normality or chi-squared, the median [M(Q25, Q75)] was reported and nonparametric tests were employed: Mann–Whitney U tests were used for intergroup comparisons and Kruskal–Wallis tests for multiple comparisons. Categorical data were presented as frequencies or percentages and intergroup comparisons were analysed using the Pearson χ 2 test or Fisher's exact tests. Multivariate analysis was performed using binary logistic regression analysis. P < 0.05 was considered a statistically significant difference. Data visualization was performed in R (version 4.4.2) with the ggplot2 package to generate stacked bar plots illustrating the temporal trends of mitral regurgitation severity. Results General clinical characteristics Among the 101 patients, 28 cases (27.7%) had new-onset persistent left bundle branch block (new-LBBB). The preoperative low-density lipoprotein cholesterol (LDL-C) level in the new-LBBB group was significantly higher than that in no-LBBB group (P 0.05). At the 6-month follow-up, there was no statistically significant difference in rehospitalization rates between the groups (P > 0.05), as shown in Table 1 . No deaths were reported within the 6-month period. Table 1 Cohort Clinical Characteristics Characteristic no-LBBB Group(N = 73) New-LBBB Group(N = 28) P value Age(year) 74.20 ± 5.89 71.96 ± 6.02 0.092 Male, n(%) 34(46.6%) 14(50.0%) 0.758 NYHA class III-IV, n (%) 54(74.0%) 19(67.9%) 0.539 Hypertension 59(80.8%) 21(75%) 0.519 Diabetes 17(23.3%) 8(28.6%) 0.582 Atrial Fibrillation 9(12.3%) 4(14.3%) 0.793 Coronary Artery Disease 45(61.6%) 16(57.1%) 0.679 Previous Myocardial Infarction 5(6.8%) 1(3.6%) 0.533 COPD 13(17.8%) 8(28.6%) 0.233 Re-hospitalization within 6 months after surgery 11(15.1)% 6(21.4%) 0.444 Heart Failure 8 4 Stroke 1 0 Pacemaker Implantation 0 2 Pulmonary Infection 2 0 Laboratory Tests Total bilirubin(mol/L) 12.20(9.95, 17.15) 12.31(9.12,15.16) 0.595 Glutamic-pyruvic transaminase(U/L) 17.90(12.20, 26.00) 17.30(15.35,23.52) 0.773 Glutamic-oxalacetic transaminase(U/L) 24.80(21.00, 32.10) 21.60(20.32,30.80) 0.598 Triglyceride 1.16 ± 0.51 1.31 ± 0.50 0.21 Total Cholesterol 4.14(3.51, 4.73) 4.91(4.09,5.40) 0.051 High Density Lipoprotein Cholesterol 1.34 ± 0.30 1.36 ± 0.33 0.778 Low Density Lipoprotein Cholesterol 2.34(1.90, 2.71) 3.31(2.50,3.77) 0.001 pre-operative BNP 499.70(91.25, 1286.70) 216.05(35.45,732.77) 0.135 Pre-discharge BNP 265.00(110.90,604.55) 167.30(98.90,384.67) 0.118 Values are represented as Mean (SD) or N (%) or Median [M(Q25,Q75)] NYHA, New York Heart Association; COPD, Chronic Obstructive Pulmonary Disease; BNP, brain natriuretic peptide P < 0.05 was considered a statistically significant difference. Comparison of Echocardiographic Parameters Between the Two Groups Preoperatively, patients with new-onset LBBB showed significantly thinner interventricular septal thickness (IVSd), lower peak aortic valve velocity, and smaller mean transvalvular pressure gradients compared to controls, along with larger effective aortic orifice area (P 0.05). Postoperatively, the prosthetic valves were implanted significantly deeper in the new-LBBB group than in controls (P 0.05), as shown in Table 2 . Binary logistic regression analysis identified both elevated LDL-C levels and deeper prosthetic valve implantation as independent influencing factors for new-onset LBBB, as shown in Table 3 . Table 2 Comparison of Echocardiographic Parameters Between the Two Groups Parameters New-LBBB Group(N = 28) No-LBBB Group(N = 73) Baseline 1 Month Follow-up 6 Month Follow-up Baseline 1 Month Follow-up 6 Month Follow-up P1 value P2 value P3 value LAD,mm 41.10 ± 5.82 41.85 ± 5.03 42.71 ± 4.95 41.93 ± 5.17 40.89 ± 4.83 39.06 ± 3.66▲ 0.491 0.526 0.001 LVEDD,mm 46(42.5,53.75) 47.50(45,50.75) 51.5(49,55.5)▲ 48(43, 54.5) 46(44,52) 44(42,48)▲ 0.643 0.001 0.001 LVESD,mm 32(28.25,37) 32(29,36) 35(31.5,40) 33(28.5, 39) 31(29, 36) 31(29,33)▲ 0.684 0.131 0.025 IVSd,mm 12(12,14) 13(12,13.75) 13(12,15) 13(12,14.5) 13(12,14) 12(12,14)▲ 0.041 0.351 0.022 LVPWd,mm 12(11,13) 12(12,13) 13(12,13) 12(12,14) 12(11,13) 12(11,13) 0.239 0.051 0.224 LVMI(g/m 2 ) 146(115.75, 188) 148(127, 183.75) 190(144.25, 213.25)▲ 160(129,197.5) 145(126, 179) 136(116, 152)▲ 0.260 0.018 <0.001 LVEF,% 60(53, 61.75) 57.5(55, 60.75) 54(52.25, 57)▲ 58(53, 62) 59(56.5, 62) 61(59,63)▲ 0.828 0.034 0.008 RVD,mm 21.32 ± 1.96 21.21 ± 2.07 21.28 ± 2.03 20.89 ± 2.03 20.82 ± 2.20 21.28 ± 2.73 0.008 0.98 0.433 RAD,mm 37.64 ± 5.83 37.78 ± 4.58 38.17 ± 5.07 37.41 ± 5.93 37.45 ± 6.27 36.67 ± 4.37 0.86 0.923 0.639 Aortic annulus diameter,mm 22(20,23) 22(21,23) 0.144 Peak aortic valve velocity, m/s 4.51 ± 0.47 2.22 ± 0.43▲ 2.20 ± 0.46▲ 4.71(4.23,5.54) 2.20(1.98,2.51)▲ 2.25(2.00,2.41)▲ 0.023 <0.001 <0.001 Mean PG,mmHg 47.00 ± 11.17 9.42 ± 2.61▲ 9.85 ± 2.63▲ 53(41.5, 70.5) 10(8, 11)▲ 10(9,11)▲ 0.035 <0.001 <0.001 Effective aortic orifice area,cm2 0.86(0.74,0.93) 0.73(0.57,0.90) 0.046 Mitral valve E-wave velocity,cm/s 70(61.5,103.50) 89(78.75,101.25) 83.5(66.25,106.75) 74(58,96) 85(65.5,108.5) 85(68.5,103.5) 0.961 0.098 0.08 Early diastolic mitral annular velocitye’,cm/s 5(4, 6) 5(4, 6.75) 5(4,6.75) 5(4, 6) 5(4, 6) 6(4, 7)▲ 0.516 0.295 0.001 E/e’ 15(11.50,19.75) 19.5(13,22.75) 15.5(12.25,19) 18(12,21) 17(14,23) 15(12,19) 0.356 0.3 0.055 Cases with LVEF < 50% (n, %) 5(17.9%) 4(14.3%) 6(21.4%) 16(21.9%) 10(13.7%) 4(5.5%)▲ 0.653 0.784 0.015 Mitral Regurgitation 0.933 0.002 <0.001 No/Trace 5(17.9%)# 18(64.3%)✱ 11(39.3%)#,✱ 13(17.8%)# 44(60.3%)✱ 46(63%)✱ Mild 16(57.1%)# 8(28.6%)✱ 7(25.0%)✱ 40(54.8%)# 26(35.6%)✱ 25(34.2%)✱ Moderate 4(14.3%)#,✱ 2(7.1%)# 9(32.1%)✱ 14(19.2%)# 3(4.1%)✱ 2(2.8%)✱ Severe 3(10.7%)# 0(0%)# 1(3.6%)# 6(8.2%)# 0(0%)✱ 0(0%)✱ Prosthetic valve implantation depth,mm 5(4,6) 3(2,4) <0.001 Paravalvular regurgitation 3(10.7%) 10(13.7%) 0.688 Mild 3 9 Moderate 0 1 Severe 0 0 Values are represented as Mean (SD) or N (%) or Median [M(Q25,Q75)] ; Note: (▲) represents a statistically significant difference compared to preoperative within the same group; Different symbols (＃, ✱) indicate statistically significant differences in mitral regurgitation within the group (Pearson’s χ² test) LAD, left atrial diameter; LVEDD,left ventricular end-diastolic diameter; LVESD,left ventricular end-systolic diameter; IVSd,Interventricular Septum thickness at end-Diastole; LVPWd,Left ventricular posterior wall thickness; LVMI,left ventricular mass index; LVEF,left ventricular ejection fraction; RVD,right ventricular diameter; RAD,right atrial diameter;Mean PG,mean transaortic pressure gradient P1 represents the comparison of preoperative parameters between the New-LBBB group and No-LBBB group; p2 represents the comparison of pre- and post-operative parameters within the New-LBBB group; P3 represents the comparison of pre- and post-operative parameters within the No-LBBB group Table 3 Binary Logistic Regression Analysis Parameters β S.E wald OR 95%CL P value Low Density Lipoprotein Cholesterol 0.746 0.344 4.699 2.109 1.074–4.142 0.03 Prosthetic valve implantation depth 1.048 0.263 15.844 2.852 1.702–4.778 <0.001 Interventricular septal thickness -0.154 0.239 0.415 0.857 0.537–1.369 0.519 Mean transaortic pressure gradient -0.024 0.03 0.638 0.976 0.919–1.036 0.424 Effective aortic orifice area 0.035 2.537 0 1.036 0.007-149.566 0.989 Intra-group Comparison of Echocardiographic Parameters Before and After Surgery At 1-month postoperative follow-up, both groups showed significant reductions in peak aortic valve velocity and mean transvalvular pressure gradient compared to preoperative values (P 0.05). At 6-month follow-up, the new-LBBB group exhibited significant increases in left ventricular diameters and LVMI with concomitant reduction in LVEF compared to preoperative baseline (all P < 0.05). In contrast, the no-LBBB group showed favourable reverse remodelling characterized by significant regression of left atrial and left ventricular diameters, decreased interventricular septal thickness, reduction in LVMI, and improvement in LVEF with fewer patients demonstrating LVEF < 50%, along with increased early diastolic mitral annular velocity (e') (all P < 0.05), as shown in Table 2 . The degree of postoperative mitral regurgitation in patients without LBBB was significantly reduced at 1-month postoperatively and remained stable by six months. In contrast, the degree of mitral regurgitation in patients with new LBBB was reduced at 1-month postoperatively, but worsened at six months (P < 0.05), as shown in Graph1,Fig. 1 and Fig. 2 . Discussion The results of this study are as follows: ① The incidence of new-onset LBBB after TAVR is about 27.7%; ② Both elevated LDL-C levels and deeper prosthetic valve implantation are independent influencing factors for new-onset LBBB; ③ Although new-onset LBBB does not significantly impact short-term rehospitalization rates, it is an unfavourable factor for early reverse cardiac structural and functional remodelling after TAVR. New-onset LBBB is the most common conduction disturbance following TAVR, with an incidence ranging from 18–64% for self-expanding valve[ 1 , 2 ]. The development of new-onset LBBB is associated with impaired outcomes after TAVR, mainly including prolonged hospitalization, an increased risk of pacemaker implantation, a higher rehospitalisation rate, and poorer survival, which puts a burden on the healthcare system that cannot be ignored[ 7 , 8 ]. This study found that the incidence of new-LBBB was approximately 27.7%, consistent with previous studies using self-expanding valves.This study found no adverse effect of LBBB on patient prognosis, which may be related to the short follow-up period. TAVR-associated conduction disturbances have been demonstrated to be predominantly caused by direct mechanical injury to the conduction system by the prosthetic valve device, and to a lesser extent, may be related to local septal hematoma or myocardial ischemia. Pre-existing left anterior hemiblock and membranous septum length are the main influencing factors[ 8 , 9 ]. Our study found that LDL-C levels and prosthesis valve implantation depth were independent predictors of new-onset LBBB following TAVR. Elevated LDL-C promotes fibrocalcific remodeling and exacerbates coronary ischemia, while deeper implantation increases mechanical compression on the basal interventricular septum, increasing conduction disturbance risk[ 10 , 11 ]. AS leads to LV pressure overload, LV hypertrophy, and myocardial hypocontractility, making reverse cardiac remodeling a key therapeutic target. Patients with reduced LVEF demonstrate immediate postprocedural LVEF improvement[ 12 ]. This study showed that the no-LBBB group exhibited reverse remodelling, characterised by a reduction in cardiac chamber diameter, a decrease in LVMI, and an increase in LVEF at six months postoperatively. It has been shown that reverse remodelling with a reduction in LVMI and relative ventricular wall thickness can occur within 30 days after TAVR, and that a greater degree of reduction is associated with a lower rate of hospitalisation at 1 year, and that each 10% reduction in LV mass index is associated with a 5% reduction in all-cause mortality at 2–5 years of follow-up[ 13 ]. In this study, patients with new-onset LBBB had increased LVMI, decreased LVEF and worsened mitral regurgitation at 6 months postoperatively, suggesting that new-LBBB is an unfavourable factor for early postoperative reverse cardiac remodelling after TAVR, which is consistent with the findings of Kim Y et al[ 14 ], who found that patients with new-onset LBBB had increased LV diameter and decreased LVEF at 1 year after TAVR. LBBB alters the sequence of ventricular depolarisation and repolarisation, leading to uncoordinated ventricular contractions resulting in LV contractile inefficiency. The septal contribution to LV systolic function is lost or attenuated and an excessive workload is placed on the LV free wall, which responds with remodelling or even decompensation[ 15 ]. Possible mitral valve tethering due to ventricular dilatation and asynchronous papillary muscle contraction can lead to increased mitral regurgitation and further deterioration of the patient's systolic and diastolic function[ 15 , 16 ]. In the present study, we found that postoperative mitral regurgitation was reduced in the no-LBBB group and was significant within one month postoperatively. This is consistent with previous findings where Abdelghani M et al found that 60% of patients with moderate to severe mitral regurgitation had a significant reduction in the degree of regurgitation at 1 month after TAVR[ 17 ]. The severity of mitral regurgitation in patients with AS is secondary to the increase of the left ventricle-to-left atrium pressure gradient(PG) and to progressive adverse LV remodelling involving the mitral valve apparatus[ 18 ]. After TAVR, the reduction in LV cavity pressure, leading to a reduction in the ventricle-to-left atrium PG, is the main mechanism for the reduction of mitral regurgitation in the early post-operative period; whereas the reduction of LV diastolic volume leading to a decrease in mitral tethering is the main factor for the further reduction in regurgitation in the later period[ 19 ]. The present study showed that the interventricular septum was thinner in the new-LBBB group, which may be due to inadequate cushioning resulting from extrusion by the prosthetic valve. Studies have shown that narrowing of left ventricular outflow tract due to significant thickening of the interventricular septum not only increases procedural complexity duringTAVR but also exacerbates mechanical injury to the conduction system, ultimately leading to conduction disturbances[ 20 ]. However, Kiefer et al found that thickening of the basal segment of the interventricular septum only increased the number of postoperative dilatations during operation and did not increase the incidence of LBBB in the 30-day postoperative period[ 21 ]. Pravda et al demonstrated that increased basal interventricular septal thickness may serve as an anatomical barrier to protect the subjacent conduction system from mechanical compression during TAVR[ 22 ]. These divergent findings are likely attributable to the well-documented anatomical variations in the spatial relationship between the conduction system and the muscular ventricular septum[ 23 ]. It should be noted that this study is subject to a number of limitations. First, this was a single-centre surgical experience, which may have introduced a degree of selection bias. Secondly, the technology of our centre is in the stage of accumulating experience, the skill of the operating physicians may have a certain impact on the incidence of new LBBB. Thirdly, the study was a short-term follow-up, and the results of the indicators cannot represent the long-term follow-up results, and the long-term results need to be further observed. In conclusion, new-onset LBBB following TAVR does not significantly impact the short-term clinical outcomes of patients. However, it may adversely affect the early reverse remodelling of cardiac structure and function. Declarations Funding This work was supported by The Third People’s Hospital of Chengdu Clinical Research Program, CSY-YN-01-2024-066. Ethical approval The study was conducted in accordance with the Declaration of Helsinki and approved by our institutional ethics committee(Number:[2023]-S-256). Verbal informed consent was obtained from the patients for this study. Competing interests The authors declare no competing interests . Author Contribution Shuzhen Wang - developed research idea, statistical analysis, wrote the main manuscript text ;Kunyue Tan-involved in statistical analysis and wrote the manuscript ;Xiaoqiang Gao-involved in statistical analysis,figures preparation;Lijuan Zhang, Chunxia Liu, Xiaofeng Huang, Shuangshuang Yan and Jing Guo -involved in data collection and manuscript preparation;Feng Xiong-revisied the manuscript.All authors have read and approved the final version. References Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;77(4):450–500. Sammour Y, Krishnaswamy A, Kumar A, et al. 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Interventricular septal thickness on cardiac computed tomography as a novel risk factor for conduction disturbances in patients undergoing transcatheter aortic valve replacement. Europace. 2024;26(5):euae113. Kawashima T, Sasaki H. A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat. 2005;27:206–13. Graphs Graph 1 is available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Graph1.png Graph 1 Changes in Mitral Regurgitation in the Two Groups Cite Share Download PDF Status: Published Journal Publication published 05 Apr, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 25 Dec, 2025 Reviews received at journal 08 Sep, 2025 Reviews received at journal 01 Sep, 2025 Reviews received at journal 31 Aug, 2025 Reviews received at journal 25 Aug, 2025 Reviewers agreed at journal 23 Aug, 2025 Reviewers agreed at journal 20 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 16 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 09 Jun, 2025 Submission checks completed at journal 09 Jun, 2025 First submitted to journal 09 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6855714","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502204124,"identity":"a79203b2-8b9f-4a7b-8333-c8c58c01a296","order_by":0,"name":"Shuzhen Wang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shuzhen","middleName":"","lastName":"Wang","suffix":""},{"id":502204127,"identity":"10fb0632-d051-44f8-8bbe-81f0a53601ef","order_by":1,"name":"Kunyue Tan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Kunyue","middleName":"","lastName":"Tan","suffix":""},{"id":502204128,"identity":"a13e890b-e34b-4755-99eb-e210c5ce0980","order_by":2,"name":"Xiaoqiang Gao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqiang","middleName":"","lastName":"Gao","suffix":""},{"id":502204129,"identity":"d4684694-bd4f-4cc0-9a2a-60de2591863a","order_by":3,"name":"Lijuan Zhang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Zhang","suffix":""},{"id":502204130,"identity":"dfc42503-6339-4135-a2a9-812ace14b583","order_by":4,"name":"Chunxia Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Chunxia","middleName":"","lastName":"Liu","suffix":""},{"id":502204131,"identity":"efbc3e96-499e-475d-839b-764528fabc33","order_by":5,"name":"Xiaofeng Huang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Huang","suffix":""},{"id":502204132,"identity":"e9495914-8f9c-4b5a-b147-6912ea23bf1e","order_by":6,"name":"Shuangshuang Yan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shuangshuang","middleName":"","lastName":"Yan","suffix":""},{"id":502204133,"identity":"f4d61c6e-8338-403f-ab39-89d8ed7a6a35","order_by":7,"name":"Jing Guo","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Guo","suffix":""},{"id":502204134,"identity":"45d2505d-f5da-412d-a690-faa7e508fe81","order_by":8,"name":"Feng Xiong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYDACZjApB8SM7R8+GNjYEavFGMQ6xjijIC2ZWLtAWtjSmHk+HGJsIKTW4DjzsYdfGAzkzPnXmD22MTjAzMB++OgGfFokm9nSjWUYDIwtZ7wxN84xuMPHwJOWdgOfFn5mHjNpCYY/iRtunDGQzjF4xswgwWOGVwsbRItBPViLhcFhxgZCWkC2SH5gMEgwON+WJs1AjBagX0AqDQw33GA+bNhjkJbMRsgvBucPH5P8UWEgb3D+YOODH39s7PjZDx/DqwUEmHkMgKREAtR3hJSDAOMPsK8OEKN2FIyCUTAKRiIAADZNRDDlc7JFAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Feng","middleName":"","lastName":"Xiong","suffix":""}],"badges":[],"createdAt":"2025-06-09 15:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6855714/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6855714/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-026-03961-w","type":"published","date":"2026-04-05T15:59:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89389535,"identity":"778fba1e-a226-4e3a-ba7f-7e63a7030905","added_by":"auto","created_at":"2025-08-19 12:48:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293908,"visible":true,"origin":"","legend":"\u003cp\u003eEchocardiography of a patient in the New-LBBB group:(a)shows trace mitral regurgitation before the operation;(b)shows trace mitral regurgitation 1 month after the operation;(c)shows mild mitral regurgitation 6 months after the operation,as the arrow points.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6855714/v1/50b53ae26f299e87be3ca783.png"},{"id":89388172,"identity":"452ade63-44ac-4976-a84a-5a52a545ca4e","added_by":"auto","created_at":"2025-08-19 12:40:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":323015,"visible":true,"origin":"","legend":"\u003cp\u003eEchocardiography of a patient in the no-LBBB group:(a)shows severe mitral regurgitation before the operation;(b)shows mild mitral regurgitation 1 month after the operation;(c)shows trace mitral regurgitation 6 months after the operation,as the arrow points.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6855714/v1/10a97ec3791ca3f11f8f2161.png"},{"id":106344806,"identity":"9b03a166-b9ec-4773-8d0d-0e36991f6669","added_by":"auto","created_at":"2026-04-07 16:16:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1497513,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6855714/v1/0b146563-6dcd-4fe7-9e7d-8e14a843d3e0.pdf"},{"id":89385880,"identity":"cac5ecd8-76e5-475c-8e4f-abd14765653a","added_by":"auto","created_at":"2025-08-19 12:32:47","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":38548,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 1 Changes in Mitral Regurgitation in the Two Groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph1.png","url":"https://assets-eu.researchsquare.com/files/rs-6855714/v1/12ff3649a7062f9415031e01.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Reversal of Cardiac Remodelling in Patients with New-onset Persistent Left Bundle Branch Block after Transcatheter Aortic Valve Replacement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTranscatheter aortic valve replacement (TAVR) has been demonstrated to be a safe and feasible alternative to surgery for patients suffering from symptomatic severe aortic stenosis(AS). Advancements in technology and increasing experience with implementation have significantly reduced the incidence of complications such as severe perivalvular regurgitation and perioperative mortality. However, cardiac conduction disturbances remain a common complication after TAVR, with left bundle branch block(LBBB) being the most prevalent, with a prevalence of 4%-65%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are fewer data on reversal of cardiac structural and functional remodelling in patients with new-onset LBBB after TAVR. In this study, the effect of new-onset LBBB on early reverse cardiac structural and functional remodelling in patients after TAVR by echocardiography was analysed. Furthermore, the impact of new-onset LBBB on the short-term rehospitalization of patients was observed.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eA total of 116 patients with severe AS who underwent successful transfemoral TAVR at our institution between March 2021 and October 2024, all with self-expanding valves, were included. Inclusion criteria were patients with severe AS who had been successfully treated with transfemoral TAVR and were older than 61 years old, with the following diagnostic criteria for severe AS: the effective aortic orifice area\u0026thinsp;\u0026lt;\u0026thinsp;1cm2 or peak aortic valve velocity\u0026thinsp;\u0026gt;\u0026thinsp;4m/s and mean transvalvular pressure gradient\u0026thinsp;\u0026ge;\u0026thinsp;40mmHg measured by transthoracic echocardiography[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Exclusion criteria included patients with a history of LBBB or pacemaker implantation, and those who developed a high degree of perioperative atrioventricular block or had a reversal of LBBB during follow-up. According to these inclusion and exclusion criteria, 3 patients with a history of pacemaker implantation, 7 patients who developed a high degree of perioperative atrioventricular block (5 of whom had pacemakers implanted), and 5 cases of LBBB reversal within 1 month were excluded from this study, and 101 patients were finally included.\u003c/p\u003e\u003cp\u003eNew-onset persistent LBBB was defined as LBBB that was not present at baseline but was present on the electrocardiogram(ECG) at discharge(QRS duration\u0026thinsp;\u0026gt;\u0026thinsp;120 ms, delayed onset of intrinsic deflection in leads V5 and V6, broad monophasic R waves that are usually notched in leads I, V5 and V6, and secondary ST- and T-wave changes in the opposite direction to the main QRS deflection)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The new-LBBB group (28 cases) and the no-LBBB group (73 cases) were categorised according to the presence or absence of new-onset persistent LBBB.\u003c/p\u003e\u003cp\u003eGeneral clinical characteristics of the patients were collected, including sex, age, past history, laboratory tests and rehospitalization. All patients underwent transthoracic echocardiography 1\u0026ndash;3 days preoperatively and at 1 month and 6 months postoperatively using an EPIQ 7C instrument with an S5\u0026minus;1 probe. The structural parameters measured by echocardiography mainly include cardiac chamber diameter, ventricular wall thickness and aortic valve annulus diameter, as well as calculation of left ventricular mass index. Biplane method was used to measure left ventricular ejection fraction(LVEF). Doppler echocardiography was used to assess hemodynamic parameters, such as peak aortic valve velocity and mean transaortic pressure gradient, to observe valve activity and to grade the degree of mitral regurgitation, which was categorized into four grades: no/trace, mild, moderate and severe[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Increased or decreased mitral regurgitation was defined as an increase or decrease in the degree of regurgitation by at least one grade or more compared with the previous examination. Perivalvular regurgitation was classified as mild, moderate, or severe according to the ratio of the perivalvular regurgitant bundle to the circumference of the aortic annulus in short-axis views of the aorta[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using SPSS Statistics version 26.0 (SPSS, Inc., Chicago, IL).Continuous variables were tested for normal distribution and chi-squared. Those satisfying both conditions were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and intergroup comparisons were performed using independent samples t-tests. Intragroup comparisons before and after surgery were analysed using F-tests, with multiple comparisons conducted using LSD t-tests. For data that did not meet the assumptions of normality or chi-squared, the median [M(Q25, Q75)] was reported and nonparametric tests were employed: Mann\u0026ndash;Whitney U tests were used for intergroup comparisons and Kruskal\u0026ndash;Wallis tests for multiple comparisons. Categorical data were presented as frequencies or percentages and intergroup comparisons were analysed using the Pearson χ\u003csup\u003e2\u003c/sup\u003e test or Fisher's exact tests. Multivariate analysis was performed using binary logistic regression analysis. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant difference. Data visualization was performed in R (version 4.4.2) with the ggplot2 package to generate stacked bar plots illustrating the temporal trends of mitral regurgitation severity.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eGeneral clinical characteristics\u003c/b\u003e Among the 101 patients, 28 cases (27.7%) had new-onset persistent left bundle branch block (new-LBBB). The preoperative low-density lipoprotein cholesterol (LDL-C) level in the new-LBBB group was significantly higher than that in no-LBBB group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were observed in the remaining baseline clinical characteristics between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). At the 6-month follow-up, there was no statistically significant difference in rehospitalization rates between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No deaths were reported within the 6-month period.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCohort Clinical Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno-LBBB Group(N\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNew-LBBB Group(N\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.96\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34(46.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.758\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA class III-IV, \u003cem\u003en\u003c/em\u003e(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54(74.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(67.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.539\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59(80.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.582\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial Fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary Artery Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45(61.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(57.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.679\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious Myocardial Infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(6.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-hospitalization within 6 months after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(15.1)%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(21.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart Failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePacemaker Implantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulmonary Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaboratory Tests\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal bilirubin(mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.20(9.95, 17.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.31(9.12,15.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlutamic-pyruvic transaminase(U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.90(12.20, 26.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.30(15.35,23.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.773\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlutamic-oxalacetic transaminase(U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.80(21.00, 32.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.60(20.32,30.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriglyceride\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.14(3.51, 4.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.91(4.09,5.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh Density Lipoprotein Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.778\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow Density Lipoprotein Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.34(1.90, 2.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.31(2.50,3.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epre-operative BNP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e499.70(91.25, 1286.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e216.05(35.45,732.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-discharge BNP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e265.00(110.90,604.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167.30(98.90,384.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are represented as Mean (SD) or N (%) or Median [M(Q25,Q75)]\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNYHA, New York Heart Association; COPD, Chronic Obstructive Pulmonary Disease; BNP, brain natriuretic peptide\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant difference.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eComparison of Echocardiographic Parameters Between the Two Groups\u003c/b\u003e Preoperatively, patients with new-onset LBBB showed significantly thinner interventricular septal thickness (IVSd), lower peak aortic valve velocity, and smaller mean transvalvular pressure gradients compared to controls, along with larger effective aortic orifice area (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant intergroup differences were observed in cardiac chamber diameters, LVEF or diastolic function parameters (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Postoperatively, the prosthetic valves were implanted significantly deeper in the new-LBBB group than in controls (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the prevalence of paravalvular regurgitation was comparable between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Binary logistic regression analysis identified both elevated LDL-C levels and deeper prosthetic valve implantation as independent influencing factors for new-onset LBBB, as shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Comparison of Echocardiographic Parameters Between the Two Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNew-LBBB Group(N\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eNo-LBBB Group(N\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 Month Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 Month Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 Month Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 Month Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP1\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP2\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eP3\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLAD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e41.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEDD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(42.5,53.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.50(45,50.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.5(49,55.5)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48(43, 54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46(44,52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e44(42,48)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVESD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(28.25,37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(29,36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(31.5,40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33(28.5, 39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31(29, 36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31(29,33)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.684\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIVSd,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(12,14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(12,13.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(12,15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13(12,14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13(12,14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12(12,14)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVPWd,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(11,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(12,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(12,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12(12,14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12(11,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12(11,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVMI(g/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e146(115.75, 188)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148(127, 183.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e190(144.25, 213.25)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e160(129,197.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e145(126, 179)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e136(116, 152)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF,%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60(53, 61.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.5(55, 60.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54(52.25, 57)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58(53, 62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59(56.5, 62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61(59,63)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRVD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRAD,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e37.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.639\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic annulus diameter,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(20,23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22(21,23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeak aortic valve velocity, m/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.71(4.23,5.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.20(1.98,2.51)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.25(2.00,2.41)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean PG,mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53(41.5, 70.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(8, 11)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10(9,11)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffective aortic orifice area,cm2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.86(0.74,0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.73(0.57,0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMitral valve E-wave velocity,cm/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70(61.5,103.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89(78.75,101.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83.5(66.25,106.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74(58,96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85(65.5,108.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e85(68.5,103.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly diastolic mitral annular velocitye\u0026rsquo;,cm/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(4, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(4, 6.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(4,6.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(4, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(4, 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(4, 7)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE/e\u0026rsquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(11.50,19.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.5(13,22.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.5(12.25,19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18(12,21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17(14,23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15(12,19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCases with LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50% (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(21.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(21.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4(5.5%)▲\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.653\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMitral Regurgitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo/Trace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(17.9%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(64.3%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(39.3%)#,✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13(17.8%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44(60.3%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46(63%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(57.1%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(28.6%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(25.0%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40(54.8%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26(35.6%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25(34.2%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(14.3%)#,✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(7.1%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(32.1%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14(19.2%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.1%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2(2.8%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(10.7%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.6%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(8.2%)#\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0(0%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0(0%)✱\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProsthetic valve implantation depth,mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(4,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(2,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParavalvular regurgitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003eValues are represented as Mean (SD) or N (%) or Median [M(Q25,Q75)] ;\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNote: (▲) represents a statistically significant difference compared to preoperative within the same group; Different symbols (＃, ✱) indicate statistically significant differences in mitral regurgitation within the group (Pearson\u0026rsquo;s \u0026chi;\u0026sup2; test)\u003c/p\u003e\n\u003cp\u003eLAD, left atrial diameter; LVEDD,left ventricular end-diastolic diameter; LVESD,left ventricular end-systolic diameter; IVSd,Interventricular Septum thickness at end-Diastole; LVPWd,Left ventricular posterior wall thickness; LVMI,left ventricular mass index; LVEF,left ventricular ejection fraction; RVD,right ventricular diameter; RAD,right atrial diameter;Mean PG,mean transaortic pressure gradient\u003c/p\u003e\n\u003cp\u003eP1 represents the comparison of preoperative parameters between the New-LBBB group and No-LBBB group;\u003c/p\u003e\n\u003cp\u003ep2 represents the comparison of pre- and post-operative parameters within the New-LBBB group;\u003c/p\u003e\n\u003cp\u003eP3 represents the comparison of pre- and post-operative parameters within the No-LBBB group\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Binary Logistic Regression Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eS.E\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ewald\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95%CL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow Density Lipoprotein Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.074\u0026ndash;4.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProsthetic valve implantation depth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.844\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.702\u0026ndash;4.778\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterventricular septal thickness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.537\u0026ndash;1.369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean transaortic pressure gradient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.919\u0026ndash;1.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffective aortic orifice area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.007-149.566\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntra-group Comparison of Echocardiographic Parameters Before and After Surgery\u003c/b\u003e At 1-month postoperative follow-up, both groups showed significant reductions in peak aortic valve velocity and mean transvalvular pressure gradient compared to preoperative values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while no significant differences were observed in cardiac chamber diameters, left ventricular mass index (LVMI), LVEF, or diastolic function parameters (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). At 6-month follow-up, the new-LBBB group exhibited significant increases in left ventricular diameters and LVMI with concomitant reduction in LVEF compared to preoperative baseline (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, the no-LBBB group showed favourable reverse remodelling characterized by significant regression of left atrial and left ventricular diameters, decreased interventricular septal thickness, reduction in LVMI, and improvement in LVEF with fewer patients demonstrating LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%, along with increased early diastolic mitral annular velocity (e') (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The degree of postoperative mitral regurgitation in patients without LBBB was significantly reduced at 1-month postoperatively and remained stable by six months. In contrast, the degree of mitral regurgitation in patients with new LBBB was reduced at 1-month postoperatively, but worsened at six months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Graph1,Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study are as follows: ① The incidence of new-onset LBBB after TAVR is about 27.7%; ② Both elevated LDL-C levels and deeper prosthetic valve implantation are independent influencing factors for new-onset LBBB; ③ Although new-onset LBBB does not significantly impact short-term rehospitalization rates, it is an unfavourable factor for early reverse cardiac structural and functional remodelling after TAVR.\u003c/p\u003e\u003cp\u003eNew-onset LBBB is the most common conduction disturbance following TAVR, with an incidence ranging from 18\u0026ndash;64% for self-expanding valve[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The development of new-onset LBBB is associated with impaired outcomes after TAVR, mainly including prolonged hospitalization, an increased risk of pacemaker implantation, a higher rehospitalisation rate, and poorer survival, which puts a burden on the healthcare system that cannot be ignored[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study found that the incidence of new-LBBB was approximately 27.7%, consistent with previous studies using self-expanding valves.This study found no adverse effect of LBBB on patient prognosis, which may be related to the short follow-up period.\u003c/p\u003e\u003cp\u003eTAVR-associated conduction disturbances have been demonstrated to be predominantly caused by direct mechanical injury to the conduction system by the prosthetic valve device, and to a lesser extent, may be related to local septal hematoma or myocardial ischemia. Pre-existing left anterior hemiblock and membranous septum length are the main influencing factors[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our study found that LDL-C levels and prosthesis valve implantation depth were independent predictors of new-onset LBBB following TAVR. Elevated LDL-C promotes fibrocalcific remodeling and exacerbates coronary ischemia, while deeper implantation increases mechanical compression on the basal interventricular septum, increasing conduction disturbance risk[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAS leads to LV pressure overload, LV hypertrophy, and myocardial hypocontractility, making reverse cardiac remodeling a key therapeutic target. Patients with reduced LVEF demonstrate immediate postprocedural LVEF improvement[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study showed that the no-LBBB group exhibited reverse remodelling, characterised by a reduction in cardiac chamber diameter, a decrease in LVMI, and an increase in LVEF at six months postoperatively. It has been shown that reverse remodelling with a reduction in LVMI and relative ventricular wall thickness can occur within 30 days after TAVR, and that a greater degree of reduction is associated with a lower rate of hospitalisation at 1 year, and that each 10% reduction in LV mass index is associated with a 5% reduction in all-cause mortality at 2\u0026ndash;5 years of follow-up[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, patients with new-onset LBBB had increased LVMI, decreased LVEF and worsened mitral regurgitation at 6 months postoperatively, suggesting that new-LBBB is an unfavourable factor for early postoperative reverse cardiac remodelling after TAVR, which is consistent with the findings of Kim Y et al[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], who found that patients with new-onset LBBB had increased LV diameter and decreased LVEF at 1 year after TAVR. LBBB alters the sequence of ventricular depolarisation and repolarisation, leading to uncoordinated ventricular contractions resulting in LV contractile inefficiency. The septal contribution to LV systolic function is lost or attenuated and an excessive workload is placed on the LV free wall, which responds with remodelling or even decompensation[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Possible mitral valve tethering due to ventricular dilatation and asynchronous papillary muscle contraction can lead to increased mitral regurgitation and further deterioration of the patient's systolic and diastolic function[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In the present study, we found that postoperative mitral regurgitation was reduced in the no-LBBB group and was significant within one month postoperatively. This is consistent with previous findings where Abdelghani M et al found that 60% of patients with moderate to severe mitral regurgitation had a significant reduction in the degree of regurgitation at 1 month after TAVR[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The severity of mitral regurgitation in patients with AS is secondary to the increase of the left ventricle-to-left atrium pressure gradient(PG) and to progressive adverse LV remodelling involving the mitral valve apparatus[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. After TAVR, the reduction in LV cavity pressure, leading to a reduction in the ventricle-to-left atrium PG, is the main mechanism for the reduction of mitral regurgitation in the early post-operative period; whereas the reduction of LV diastolic volume leading to a decrease in mitral tethering is the main factor for the further reduction in regurgitation in the later period[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe present study showed that the interventricular septum was thinner in the new-LBBB group, which may be due to inadequate cushioning resulting from extrusion by the prosthetic valve. Studies have shown that narrowing of left ventricular outflow tract due to significant thickening of the interventricular septum not only increases procedural complexity duringTAVR but also exacerbates mechanical injury to the conduction system, ultimately leading to conduction disturbances[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, Kiefer et al found that thickening of the basal segment of the interventricular septum only increased the number of postoperative dilatations during operation and did not increase the incidence of LBBB in the 30-day postoperative period[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Pravda et al demonstrated that increased basal interventricular septal thickness may serve as an anatomical barrier to protect the subjacent conduction system from mechanical compression during TAVR[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These divergent findings are likely attributable to the well-documented anatomical variations in the spatial relationship between the conduction system and the muscular ventricular septum[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt should be noted that this study is subject to a number of limitations. First, this was a single-centre surgical experience, which may have introduced a degree of selection bias. Secondly, the technology of our centre is in the stage of accumulating experience, the skill of the operating physicians may have a certain impact on the incidence of new LBBB. Thirdly, the study was a short-term follow-up, and the results of the indicators cannot represent the long-term follow-up results, and the long-term results need to be further observed.\u003c/p\u003e\u003cp\u003eIn conclusion, new-onset LBBB following TAVR does not significantly impact the short-term clinical outcomes of patients. However, it may adversely affect the early reverse remodelling of cardiac structure and function.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by The Third People\u0026rsquo;s Hospital of Chengdu Clinical Research Program, CSY-YN-01-2024-066.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by our institutional ethics committee(Number:[2023]-S-256). Verbal informed consent was obtained from the patients for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShuzhen Wang - developed research idea, statistical analysis, wrote the main manuscript text ;Kunyue Tan-involved in statistical analysis and wrote the manuscript ;Xiaoqiang Gao-involved in statistical analysis,figures preparation;Lijuan Zhang, Chunxia Liu, Xiaofeng Huang, Shuangshuang Yan and Jing Guo -involved in data collection and manuscript preparation;Feng Xiong-revisied the manuscript.All authors have read and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOtto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;77(4):450\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSammour Y, Krishnaswamy A, Kumar A, et al. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2021;14(2):115\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaumgartner H, Hung J, Bermejo J. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSurawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53:976\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30:303\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZoghbi WA, Asch FM, Bruce C. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2019;32:431\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazif TM, Chen S, George I, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER II trial. Eur Heart J. 2019;40:2218\u0026ndash;2217.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNuche J, Ellenbogen KA, Mittal S, et al. Conduction\u0026ensp;Disturbances\u0026ensp;After\u0026ensp;Transcatheter\u0026ensp;Aortic\u0026ensp;Valve\u0026ensp;Replacement: An Update on Epidemiology, Preventive Strategies, and Management. JACC Cardiovasc Interv. 2024;17(22):2575\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015;8:1218\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eC\u0026ocirc;T\u0026eacute; C, PIBAROT P, DESPR\u0026eacute;S JP, et al. Association between circulating oxidised low-density lipoprotein and fibrocalcific remodelling of the aortic valve in aortic stenosis. Heart. 2008;94(9):1175\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZaid S, Sengupta A, Okoli K, et al. Novel Anatomic Predictors of New Persistent Left Bundle Branch Block After Evolut Transcatheter Aortic Valve Implantation. Am J Cardiol. 2020;125(8):1222\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHayashi Y, Miyake R, Sigurdsson G, et al. Immediate change following valve deployment in left ventricular systolic and diastolic functions in transcatheter aortic valve replacement: a retrospective cohort study. J Thorac Dis. 2024;16(9):5643\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChau KH, Douglas PS, Pibarot P, et al. Regression of left ventricular mass after transcatheter aortic valve replacement: the PARTNER trials and registries. J Am Coll Cardiol. 2020;75:2446\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim Y, Ko YG, Shim CY, et al. Impact of New-Onset Persistent Left Bundle Branch Block on Reverse Cardiac Remodeling and Clinical Outcomes After Transcatheter Aortic Valve Replacement. Front Cardiovasc Med. 2022;27:9893878.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107(6):927\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmiseth OA, Aalen JM. Mechanism of harm from\u0026ensp;left\u0026ensp;bundle\u0026ensp;branch\u0026ensp;block. Trends Cardiovasc Med. 2019;29:335\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdelghani M, Abdel-Wahab M, Hemetsberger R, et al. Fate and long-term prognostic implications of mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Int J Cardiol. 2019;288:39\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrener SJ, Duffy CI, Thomas JD, et al. Progression of aortic stenosis in 394 patients: relation to changes in myocardial and mitral valve dysfunction. J Am Coll Cardiol. 1995;25:305\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnger P, Dedobbeleer C, Van Camp G, et al. Mitral regurgitation in patients with aortic stenosis undergoing valve replacement. Heart. 2010;96:9\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreno R, Calvo L, Garc\u0026iacute;a E et al. (2010) Severe septal hypertrophy: is it necessarily a contraindication for the transcatheter implantation of an Edwards-SAPIEN prosthesis? Rev Esp Cardiol 2010, 63:241\u0026ndash;242.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKiefer NJ, Salber GC, Burke GM, et al. The Impact of Basal Septal Hypertrophy on Outcomes after Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr. 2019;32:1416\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePravda NS, Shaleve Y, Plakht Y, et al. Interventricular septal thickness on cardiac computed tomography as a novel risk factor for conduction disturbances in patients undergoing transcatheter aortic valve replacement. Europace. 2024;26(5):euae113.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKawashima T, Sasaki H. A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat. 2005;27:206\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraph 1 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"New-onset left bundle branch block, Transcatheter aortic valve replacement, Echocardiography, Cardiac Remodelling","lastPublishedDoi":"10.21203/rs.3.rs-6855714/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6855714/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eOBJECTIVE\u003c/b\u003e New-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR) is an independent predictor of long-term cardiovascular mortality in patients. The aim of this study is to evaluate the impact of new-onset LBBB on early cardiac reverse remodelling and clinical outcomes after TAVR.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMETHODS\u003c/b\u003e A retrospective analysis was performed on 101 patients who underwent successful TAVR for severe aortic stenosis between March 2021 and October 2024 at our institution. Echocardiographic variables indicative of cardiac remodelling were analysed preoperatively and at one and six months after TAVR. Furthermore, the clinical outcomes of the patients were monitored during the follow-up period.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRESULT\u003c/b\u003e Of the 101 patients who underwent TAVR, 28 (27.7%) had new-onset LBBB. Prosthetic valve implantation depth and serum low-density lipoprotein cholesterol levels were influential factors of new LBBB, which was more prevalent in patients with thinner interventricular septal thickness preoperatively. At the six-month follow-up, new-LBBB group showed an increase in left ventricular diameter and left ventricular mass index and a reduction in left ventricular ejection fraction compared with the preoperative period. Mitral regurgitation in no-LBBB group was significantly reduced at 1 month postoperatively and remained stable by six months. In contrast, mitral regurgitation in new-LBBB group was reduced at one month postoperatively, but worsened at six months.There was no significant difference in rehospitalization within 6 months postoperatively between patients with or without LBBB.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCONCLUSIONS\u003c/b\u003e New-onset persistent LBBB after TAVR did not affect short-term rehospitalization, but may adversely affect early postoperative reversal of cardiac remodelling.\u003c/p\u003e","manuscriptTitle":"Early Reversal of Cardiac Remodelling in Patients with New-onset Persistent Left Bundle Branch Block after Transcatheter Aortic Valve Replacement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:32:42","doi":"10.21203/rs.3.rs-6855714/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-25T14:46:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T08:06:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-02T00:24:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-31T14:21:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-25T09:57:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263105461049428046779391603978672529536","date":"2025-08-23T18:35:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181149818527573905577056471114951923569","date":"2025-08-20T21:39:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325166461892780923633123176281057767678","date":"2025-08-19T07:42:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9145012847875511558179211605051887903","date":"2025-08-18T22:52:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284005850249614149925201840770633311562","date":"2025-08-18T16:21:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196913306197663494540742883475999162296","date":"2025-08-16T17:10:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204547075864432352718051617555693225625","date":"2025-08-11T22:07:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T15:31:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-10T03:20:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-10T03:20:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-06-09T15:01:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c52742e1-ca38-43d2-8b6c-96eef00c72db","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:13:25+00:00","versionOfRecord":{"articleIdentity":"rs-6855714","link":"https://doi.org/10.1186/s13019-026-03961-w","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2026-04-05 15:59:55","publishedOnDateReadable":"April 5th, 2026"},"versionCreatedAt":"2025-08-19 12:32:42","video":"","vorDoi":"10.1186/s13019-026-03961-w","vorDoiUrl":"https://doi.org/10.1186/s13019-026-03961-w","workflowStages":[]},"version":"v1","identity":"rs-6855714","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6855714","identity":"rs-6855714","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}