Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 12; no. 1; p. 66
• Main Authors: Altes, A., Sochala, M., Attias, D., Dreyfus, J., Bohbot, Y., Toledano, M., Macron, L., Renard, C., Chadha, G., Truffier, A., Guerbaai, R.A., Ennezat, P.V., Graux, P., Tribouilloy, C., Maréchaux, S.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2020
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2019.09.139

Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS). To identify the factors associated with increased AT/ET. The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were retrospectively analyzed 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. 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 a Vmax≥4m/s, an MPG≥40mmHg, or an AVA≤1.0cm2, with an optimal cut-off value of 0.34. Multivariate linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure (SBP), 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) (Fig. 1). 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.