Work

External validation of the D-PACE score for predicting late high-grade atrioventricular block after transcatheter aortic valve replacement in a Colombian cohort

Year: 2026

Type: article

Abstract: Background Transcatheter aortic valve replacement (TAVR) carries a clinically significant risk of late high-grade atrioventricular block (AVB), yet no validated tool exists to predict this complication in Latin-American populations. The D-PACE score was developed in European cohorts for this purpose. Methods In a retrospective cohort of 175 consecutive TAVR procedures at a Colombian center (2012–2025), 141 patients met inclusion criteria for D-PACE validation. The primary outcome was late high-grade AVB (≥Mobitz type II) occurring between 24 h and 30 days post-TAVR. Discrimination, logistic-regression calibration, and decision curve analysis were performed. Results Late AVB occurred in 31 patients (22.0%), with 80.6% of events within 72 h. The D-PACE score demonstrated good discrimination (AUC 0.82; 95% CI 0.71–0.92; sensitivity 77.4%, specificity 86.4% at a cutoff of 5.5 points; NPV 93.1%). Late AVB rates rose progressively across strata: 5.9% (low-risk, score 0–3), 8.8% (intermediate, 4–5), and 61.5% (high-risk, ≥6), with the high-risk group concentrating 77.4% of all events. Decision curve analysis confirmed net clinical benefit across threshold probabilities from 8% to 60%. All four low-risk events occurred among valve-in-valve patients assigned a score of 0 per the original algorithm; excluding this subgroup ( N = 114), the AUC rose to 0.91 (95% CI 0.85–0.96) with zero low-risk events. In an exploratory analysis applying the full seven-variable scoring uniformly, including valve-in-valve cases, the AUC was 0.90 (95% CI 0.85–0.95; NPV 96.7%), and 0.91 (95% CI 0.78–1.00) within the valve-in-valve subgroup ( N = 27, 4 events). Conclusions Applied as originally specified, the D-PACE score showed good discrimination for late high-grade AVB in this cohort (AUC 0.82; 95% CI 0.71–0.92). The algorithm's automatic low-risk classification of valve-in-valve patients was not supported (14.8% AVB rate). Discrimination was higher both in the sensitivity analysis excluding valve-in-valve cases and in the exploratory analysis applying the seven-variable scoring uniformly, indicating that the scoring variables transfer well while the valve-in-valve exemption warrants reconsideration. These findings provide the first external validation of D-PACE in Latin America.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1905818

Authors: Juan David Zuluaga-Monroy, Hugo Oswaldo Alvarado Mora, Diana Fernanda Bohórquez González, Joshua Kock Sierra, Edgar Fernando Hurtado Ordoñez

Institution: Universidad de La Sabana

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801