Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity

Gamaza-Chulián, Sergio; Freire, Santiago Jesús Camacho; Toro, Rocío; Giráldez-Valpuesta, Alberto; Benezet-Mazuecos, Javier; Vargas-Machuca, José Carlos

doi:10.1111/echo.12978

Cited by 20 publications

(8 citation statements)

References 37 publications

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“…The current findings are similar to observations made in patients with AS, with several studies reporting an increased AT in severe AS [4][5][6][7]. Mean AT values are generally lower in these patients.…”

Section: Discussionsupporting

confidence: 91%

“…A potential explanation lies in the assessment of acceleration time (AT), defined as the interval between the onset of ejection flow and the peak velocity (PV), which has been tested in a variety of clinical settings [4][5][6][7][8][9]. Previous studies in patients with aortic stenosis (AS) have demonstrated that an increase in stenosis severity leads to increased AT [4][5][6][7]. The aim of this study is to assess the relation between clinical characteristics and echocardiographic measurements, including AT and symptoms in obstructive HCM patients.…”

Section: Introductionmentioning

confidence: 99%

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Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

et al. 2020

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Aims Not all obstructive hypertrophic cardiomyopathy (HCM) patients are symptomatic. The relation between obstructive HCM and symptoms is not well understood. The hypothesis of this study is that left-ventricular outflow tract (LVOT) acceleration time (AT) is associated with symptoms. Methods We included 187 patients (61% men, mean age 55 ± 14 years) with obstructive HCM, defined as a maximal wall thickness ≥ 15 mm and a resting or provoked LVOT peak gradient ≥ 30 mmHg. Peak velocity (PV), left-ventricular (LV) ejection time (ET), and AT (the time between LVOT flow onset and the moment of PV) were measured on continuous-wave (CW) Doppler tracings. Logistic and Cox proportional hazard regression analyses were used to evaluate the relation between symptoms [New York Heart Association (NYHA) class ≥ II] and echocardiographic measurements, including AT. Reproducibility was assessed using the intraclass correlation coefficient (ICC). Results Symptomatic patients were more often female and had higher mean AT values. Logistic regression demonstrated a significant association between AT and symptomatic status (odds ratio 1.31 per 10 ms, p < 0.01) after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction. AT was independently associated with symptoms and septal reduction during follow-up (hazard ratio 1.09 per 10 ms, p < 0.05). The ICC was 0.98 with a mean difference of 0.28 ± 8.4 ms. Conclusion In obstructive HCM patients, increased AT is significantly related to symptoms after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction, and is associated with the symptomatic status during follow-up. AT represents an easily measured echocardiographic variable with excellent inter-reader reproducibility.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

et al. 2020

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“…In our study, the mean age was 61 years which was younger in comparison with western literature as per the study done by Gamaza-Chulián et al . [10] The most common cause of AS was degenerative (50%) followed by bicuspid aortic valve (BAV) (36%). In a study done by Gamaza-Chulián et al .…”

Section: Discussionmentioning

confidence: 99%

“…mean age of patients with AS was 77 years and their most common cause was degenerative (92%). [10] In a study done in the Indian population, degenerative calcification was found to be the most common cause (65.0%) followed by BAV (33.9%), and their maximum patients were in 60–69 years of age gap. [4] Hence, our study is in concurrence of observations with regards to studies done at other Indian centers but in discordance with western studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of grading of aortic stenosis between transthoracic and transesophageal echocardiography in adult patients undergoing elective aortic valve replacement surgeries: A prospective observational study

et al. 2019

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Introduction: Intraoperative trans-esophageal echocardiography (TEE) has been found to underestimate severity of aortic stenosis (AS) compared to trans-thoracic echo (TTE). We conducted a prospective study comparing pre induction TTE and intra operative TEE grading of AS in patients posted for aortic valve replacement surgeries. Methods: Sixty patients with isolated AS who were undergoing aortic valve replacement were enrolled in our study. Baseline TTE was done and after induction of anesthesia, TEE was done. Mean gradient across aortic valve, peak jet velocity, aortic valve area (AVA) by continuity equation and dimensionless index (DI) were assessed in both. Results: Mean gradient decreased from 56.4 in TTE to 39.8 mm Hg in TEE leading to underestimation of AS in 74.5% of patients ( P < 0.0). Mean of peak jet velocity also decreased from 500 in TTE to 386cm/s in TEE ( P < 0.01). In 76 % of patients this led to reduction of AS grade from severe to moderate. Mean AVA was 0.67 cm 2 in TTE and 0.69 cm 2 in TEE. Though there was 0.02 cm 2 increase, it was not statistically significant ( P = 0.07). All the patients remained as severe AS in TEE. DI mean was 0.19 in both TTE and TEE ( P = 0.14).It led to underestimation of severity in 6% of patients in TEE. Conclusion: Our study shows that AVA measurement by continuity equation and DI are reliable in grading aortic stenosis while performing intraoperative TEE. Mean gradient and jet velocity can be significantly reduced.

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“…This index was also noted to be angle-independent. In moderate or worse degrees of valvular AS, an AT:ET >0.35 identified symptomatic AS (sensitivity 77%, specificity 100%) and was associated with higher serum NT-proBNP levels [57]. The same optimal AT:ET cut-off of !0.35 was also able to reasonably differentiate severe AS from mild or moderate disease (sensitivity 59%, specificity 86%) in a larger cohort of patients [58].…”

Section: Acceleration Time/ejection Time (At/et) Ratiomentioning

confidence: 95%

Contemporary Imaging of Aortic Stenosis

Chong

Senior

Wahi

2019

Heart, Lung and Circulation

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Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity

Abstract: Ejection dynamics through aortic valve, particularly AT/ET ratio, is a useful tool for assessing aortic stenosis severity, with a good correlation with flow-independent parameters in aortic stenosis.

Cited by 20 publications

References 37 publications

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

Comparison of grading of aortic stenosis between transthoracic and transesophageal echocardiography in adult patients undergoing elective aortic valve replacement surgeries: A prospective observational study

Contemporary Imaging of Aortic Stenosis

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