{
  "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.\n\nMethods: 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.\n\nResults: 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).\n\nConclusions: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Interventional Cardiology, Fundación Abood Shaio",
    "Department of Clinical Epidemiology, Universidad de La Sabana"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Juan David Zuluaga-Monroy"
    },
    {
      "affs": [
        0
      ],
      "name": "Hugo Oswaldo Alvarado Mora"
    },
    {
      "affs": [
        0
      ],
      "name": "Diana Fernanda Bohórquez González"
    },
    {
      "affs": [
        1
      ],
      "name": "Joshua Kock Sierra"
    },
    {
      "affs": [
        0
      ],
      "name": "Edgar Fernando Hurtado Ordoñez"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e3233tq2zd9sc.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1905818",
  "fulltext_url": "https://europepmc.org/articles/PMC13713820",
  "id": "e3233tq2zd9sc",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905818/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Cardiac Valve Diseases and Treatments"
    ]
  ],
  "openalex": "W7221747059",
  "pdf_url": "https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2026.1905818/pdf",
  "pmcid": "PMC13713820",
  "pmid": "42953160",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/e3233tq2zd9sc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1905818",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905818/full"
    },
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953160",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953160"
    },
    {
      "first_seen": "2026-11-01T12:21:25Z",
      "native_id": "PMC13713820",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fcvm.2026.1905818"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "External validation of the D-PACE score for predicting late high-grade atrioventricular block after transcatheter aortic valve replacement in a Colombian cohort",
  "title_text": "External validation of the D-PACE score for predicting late high-grade atrioventricular block after transcatheter aortic valve replacement in a Colombian cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:25Z",
  "url": "https://research.draconitic.com/paper/e3233tq2zd9sc",
  "venue": "Frontiers in Cardiovascular Medicine",
  "versions": []
}