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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

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

  • Juan David Zuluaga-Monroy1
  • Hugo Oswaldo Alvarado Mora1
  • Diana Fernanda Bohórquez González1
  • Joshua Kock Sierra2
  • Edgar Fernando Hurtado Ordoñez1
  1. 1Department of Interventional Cardiology, Fundación Abood Shaio
  2. 2Department of Clinical Epidemiology, Universidad de La Sabana
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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.

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Cite

BibTeXRIS
BibTeX
@article{zuluagamonroy2026external,
  title = {{External validation of the D-PACE score for predicting late high-grade atrioventricular block after transcatheter aortic valve replacement in a Colombian cohort}},
  author = {Juan David Zuluaga-Monroy and Hugo Oswaldo Alvarado Mora and Diana Fernanda Bohórquez González and Joshua Kock Sierra and Edgar Fernando Hurtado Ordoñez},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1905818},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905818/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - External validation of the D-PACE score for predicting late high-grade atrioventricular block after transcatheter aortic valve replacement in a Colombian cohort
AU  - Juan David Zuluaga-Monroy
AU  - Hugo Oswaldo Alvarado Mora
AU  - Diana Fernanda Bohórquez González
AU  - Joshua Kock Sierra
AU  - Edgar Fernando Hurtado Ordoñez
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1905818
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905818/full
AB  - 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.
SN  - 2297-055X
ER  -