Valor pronóstico del ratio tiempo de aceleración/tiempo de eyección en la estenosis valvular aórtica

Introduction

Guidelines underline the importance of assessment of aortic flow waveform morphology to estimate aortic stenosis (AS) severity. Our aim was to evaluate acceleration time/ejection time ratio (AT/ET) as prognostic value in this disease.

Methods

Between January 2013 and July 2016, patients with severe AS (aortic valve area < 1 cm²) who came to our echocardiography laboratory were included. We analyzed in the aortic flow in continuos Doppler wave the time between the onset and the peak velocity (acceleration time), and total ejection time, and then acceleration time/ejection time ratio was calculated. The primary end-point was a combined one of cardiovascular death or aortic valve replacement.

Results

One hundred and ninety-seven patients with severe AS were included (55% women, mean age 76 ± 8 years). Complete follow-up was achieved in 190 patients (96%): during a mean follow-up of 223 ± 156 days, 110 patients (58%) reached the primary endpoint; 70 patients (37%) were surgically operated, 8 patients (4%) percutaneous replacement, 33 patients (17%) suffered from cardiovascular death. Patients with AT/ET higher than 0.35 had more cardiovascular events (66% vs. 41%, P = .008). There was a non-significant trend to lower free-events survival by Kaplan-Meier method in patients with AT/ET higher than 0.35 (284 ± 25 vs. 350 ± 32 days, P = .07). In multivariate analysis by Cox regression, only aortic valve area (P = .03), atrial fibrillation (P = .02), symptomatic status (P < .001) and AT/ET (P = .04) were independent predictors of combined end-point.

Conclusion

AT/ET ratio could help to identify patients with more severe AS. Higher values of AT/ET ratio were associated with higher incidence of aortic valve replacement and/or cardiovascular death.