Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve

Abstract

Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (T LV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS. OBJECTIVE To investigate the diagnostic utility of measuring catheter-based T LV-Ao in patients with severe AS. DESIGN, SETTING, AND PARTICIPANTS We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and T LV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016. MAIN OUTCOMES AND MEASURES The association between T LV-Ao and AVC or other conventional imaging parameters was analyzed. RESULTS Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) T LV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher T LV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding T LV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher T LV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03). CONCLUSIONS AND RELEVANCE Prolonged T LV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of T LV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.

Comparison of flow-independent parameters for grading severity of aortic stenosis using intraoperative transesophageal echocardiography – A prospective observational study

“…Delayed AT and prolonged ET measured by echocardiography are associated with severity of AS. [ 16 ] AT/ET has been found to be relatively flow-independent. [ 17 ] We obtained a 43.3% disparity with AT/ET ratio pointing toward its flow dependency.…”

Prognostic Impact of the Ratio of Acceleration Time to Ejection Time in Patients With Low Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

“…We recently shown that prolonged AT/ET is a valuable parameter to predict mortality in unselected patients with at least moderate AS, with a prognostic cut-off value of 0.36 9 . Sato et al have recently shown that prolonged time between left ventricular and aortic systolic pressure peaks measured by left cardiac catheterization is associated with SAS according to aortic valve calcification scoring, including a subgroup of patients with LG-SAS 22 . To the best of our knowledge, no study has specifically studied the relationship between AT/ET ratio and outcome in patients with LG-SAS and preserved EF.…”

Cerebral Ischemic Lesions after Transcatheter Aortic Valve Implantation in Patients with Non-Calcific Aortic Stenosis

“…The new cerebral ischemic lesions were evaluated in DWI sequence, fluid-attenuated inversion recovery sequence, and apparent diffusion coefficient maps by two independent authors, and they were confirmed by a neurologist. The analysts only knew that the patients underwent TAVI and their basic information such as the patient’s name and gender, without knowing the patient’s anatomical data (including echocardiographic and CT characteristics) and procedural data [ 15 ]. The volume of CILs was analyzed in DWI sequence using MRIcron software Version 4 (NeuroImaging Tools and Resources Collaboratory, South Carolina).…”