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Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study
Authors : A Altes (Lille,FR), M Sochala (Saint Denis,FR), D Attias (Saint Denis,FR), J Dreyfus (Saint Denis,FR), M Toledano (Lille,FR), L Macron (Saint Denis,FR), C Renard (Amiens,FR), A Truffier (Lille,FR), RA Guerbaai (Basel,CH), PV Ennezat (Grenoble,FR), P Graux (Lille,FR), C Tribouilloy (Amiens,FR), S Marechaux (Lille,FR)
A. Altes1
,
M. Sochala2
,
D. Attias2
,
J. Dreyfus2
,
M. Toledano1
,
L. Macron2
,
C. Renard3
,
A. Truffier1
,
R.A. Guerbaai4
,
P.V. Ennezat5
,
P. Graux1
,
C. Tribouilloy3
,
S. Marechaux1
,
1Lille Catholic University - Lille - France
,
2Centre Cardiologique du Nord (CCN) - Saint Denis - France
,
3UPJV Amiens - Amiens - France
,
4University of Basel - Basel - Switzerland
,
5University Hospital of Grenoble - Grenoble - France
,
Background: Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS).
Purpose: To identify the determinants associated with increased AT/ET.
Methods: The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were studied in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography – Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients.
Results: In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r=0.57, p<0.0001), mean pressure gradient (MPG, r=0.60, p<0.0001), aortic valve area (AVA, r=−0.50, p<0.0001) and CT-AVC score (r=0.24, p<0.0001). An AT/ET ratio had a good accuracy to predict an aortic peak velocity ≥4 m/s, a MPG≥40 mmHg, or an AVA≤1.0 cm2, with an optimal cut-off value of 0.34. By multivariate linear regression analysis, presence of AS-related symptoms, decreased LV stroke volume index, LVEF, systolic blood pressure (SBP), absence of diabetes mellitus, and increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P<0.05).
Conclusion: AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.
ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
