Alexandre Altes1, Maximilien Sochala2, David Attias2, Julien Dreyfus2, Yohann Bohbot3, Manuel Toledano1, Laurent Macron2, Cedric Renard3, Gagandeep Chadha3, Arianne Truffier1, Raphaëlle A Guerbaai4, Pierre Vladimir Ennezat5, Pierre Graux1, Christophe Tribouilloy6, Sylvestre Maréchaux7. 1. Echocardiography Laboratory, Heart Valve Centre, Cardiology and Radiology Departments, Faculté de médecine et de Maïeutique, GCS-groupement des hôpitaux de l'institut catholique Lillois, UCLille, 59000 Lille, France. 2. Centre cardiologique du Nord, Cardiology and Radiology Departments, 93200 Saint-Denis, France. 3. Cardiology and Radiology Departments, centre hospitalier universitaire d'Amiens, 80480 Amiens, France. 4. Department of Public Health (DPH), Faculty of Medicine, University of Basel, 4056 Basel, Switzerland. 5. Cardiology Department, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France. 6. Cardiology and Radiology Departments, centre hospitalier universitaire d'Amiens, 80480 Amiens, France; Laboratoire UPJV, université de Picardie, 80025 Amiens, France. 7. Echocardiography Laboratory, Heart Valve Centre, Cardiology and Radiology Departments, Faculté de médecine et de Maïeutique, GCS-groupement des hôpitaux de l'institut catholique Lillois, UCLille, 59000 Lille, France; Laboratoire UPJV, université de Picardie, 80025 Amiens, France. Electronic address: sylvestre.marechaux@gmail.com.
Abstract
BACKGROUND: An increased acceleration time to ejection time (AT/ET) ratio is associated with increased mortality in patients with aortic stenosis (AS). AIM: To identify the factors associated with an increased AT/ET ratio. METHODS: The relationships between the AT/ET ratio and clinical and Doppler echocardiographic variables of interest in the setting of AS were analysed retrospectively in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (LVEF). The computed tomography aortic valve calcium (CT-AVC) score was studied in a subgroup of 342 patients. RESULTS: In the univariate analysis, the AT/ET ratio was found to correlate with peak aortic jet velocity (r=0.57; P<0.0001), mean pressure gradient (r=0.60; P<0.0001), aortic valve area (r=-0.50; P<0.0001) and CT-AVC score (r=0.24; P<0.0001). The AT/ET ratio had good accuracy in predicting a peak aortic jet velocity≥4 m/s, a mean pressure gradient≥40mmHg and an aortic valve area≤1.0cm2, with an optimal cut-off value of 0.34. Multivariable linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure, increased LV mass index, relative wall thickness and peak aortic jet velocity were independently associated with an increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC scoring, the CT-AVC score was independently associated with an increased AT/ET ratio (P<0.05). CONCLUSIONS: The AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond the haemodynamic and anatomical severity of AS influence the AT/ET ratio, including LV geometry, function and systolic blood pressure. These findings should be considered when assessing the AT/ET ratio in patients with AS and preserved LVEF.
BACKGROUND: An increased acceleration time to ejection time (AT/ET) ratio is associated with increased mortality in patients with aortic stenosis (AS). AIM: To identify the factors associated with an increased AT/ET ratio. METHODS: The relationships between the AT/ET ratio and clinical and Doppler echocardiographic variables of interest in the setting of AS were analysed retrospectively in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (LVEF). The computed tomography aortic valve calcium (CT-AVC) score was studied in a subgroup of 342 patients. RESULTS: In the univariate analysis, the AT/ET ratio was found to correlate with peak aortic jet velocity (r=0.57; P<0.0001), mean pressure gradient (r=0.60; P<0.0001), aortic valve area (r=-0.50; P<0.0001) and CT-AVC score (r=0.24; P<0.0001). The AT/ET ratio had good accuracy in predicting a peak aortic jet velocity≥4 m/s, a mean pressure gradient≥40mmHg and an aortic valve area≤1.0cm2, with an optimal cut-off value of 0.34. Multivariable linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure, increased LV mass index, relative wall thickness and peak aortic jet velocity were independently associated with an increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC scoring, the CT-AVC score was independently associated with an increased AT/ET ratio (P<0.05). CONCLUSIONS: The AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond the haemodynamic and anatomical severity of AS influence the AT/ET ratio, including LV geometry, function and systolic blood pressure. These findings should be considered when assessing the AT/ET ratio in patients with AS and preserved LVEF.