OP-175 Ratio of Aortic Flow Acceleration Time to Deceleration Time: A Novel Echocardiographic Parameter for Reduced LVEF?

Diagnosing prosthetic aortic valve (PAV) stenosis, especially in mechanical valves, is challenging. We postulated that ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET) can differentiate PAV stenosis from normals and those with patient-prosthesis mismatch. Doppler echocardiographic studies were reviewed and quantitated in 74 patients with PAV (38 mechanical and 36 bioprosthetic; age 61±23.6 years; valve size range). Three groups of patients were identified: patients with normal prostheses (n=60) evaluated within 3 months of surgery patients with patient-prosthesis mismatch (n=10) and documented PAV stenosis (n=14) with surgical confirmation. Quantitative Doppler parameters included ejection dynamics (AT, ET and AT/ET) and conventional PAV parameters of effective orifice area (EOA) and gradient. Summary of the Doppler parameters is presented in Table 1 . Patient with PAV stenosis had significantly lower EOA and higher gradients compared to normals and mismatch. Flow ejection parameters (ET, AT and AT/ET) were significantly longer in the stenotic valves. Patients with prosthetic mismatch, while having a normal absolute EOA, had gradients and ejection dynamics intermediate, between normal and stenotic valves. Receiver-Operating characteristic curve analysis showed that AT discriminated best PAV stenosis from normals and patients with mismatch (area under ROC=0.97). A cut off of AT = 100 msec had a sensitivity of 93% and specificity of 88% for PAV stenosis. In prosthetic aortic valves, ejection dynamics, particular acceleration time, are reliable, angle independent diagnostic parameters for identifying prosthetic valve stenosis. Table 1: Doppler Echocardiographic parameters in normal PAV, stenotic valves and patients with mismatch.

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The feasibility and clinical implication of tricuspid regurgitant velocity and pulmonary flow acceleration time evaluation for pulmonary pressure assessment during exercise stress echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez029 ◽

2019 ◽

Vol 20 (9) ◽

pp. 1027-1034 ◽

Cited By ~ 7

Author(s):

Karina Wierzbowska-Drabik ◽

Eugenio Picano ◽

Eduardo Bossone ◽

Quirino Ciampi ◽

Piotr Lipiec ◽

...

Keyword(s):

Stress Echocardiography ◽

Continuous Wave ◽

Close Correlation ◽

Exercise Stress ◽

Peak Exercise ◽

Acceleration Time ◽

Flow Acceleration ◽

Exercise Stress Echocardiography ◽

Pulmonary Flow ◽

Pulmonary Arterial

Abstract Aims Echocardiography can estimate pulmonary arterial pressure (PAP) from tricuspid regurgitation velocity (TRV) or acceleration time (ACT) of pulmonary flow. We assessed the feasibility of TRV and ACT measurements during exercise stress echocardiography (ESE) and their correlation in all stages of ESE. Methods and results We performed ESE in 102 subjects [mean age 49 ± 17 years, 50 females, 39 healthy, 30 with cardiovascular risk factors, and 33 with pulmonary hypertension (PH)] referred for the assessment of exercise tolerance and ischaemia exclusion. ESE was performed on cycloergometer with the load increasing by 25 W for each 2 min. Assessment of TRV with continuous wave and ACT with pulsed Doppler were attempted in 306 time points: at rest, peak exercise, and recovery. In 20 PH patients we evaluated the correlations of TRV and ACT with invasively measured PAP. The success rate was 183/306 for TRV and 304/306 for ACT (feasibility: 60 vs. 99%, P < 0.0001). There was a close correlation between TRV and ACT: r = 0.787, P < 0.001 and ACT at peak ≤67 ms showed 94% specificity for elevated systolic PAP detection. Moreover, TRV and ACT at peak exercise reflected better that resting data the invasive systolic PAP and mean PAP with r = 0.76, P = 0.0004 and r = −0.67, P = 0.0018, respectively. Conclusion ACT is closely correlated with and substantially more feasible than TRV during ESE and inclusion of both parameters (TRACT approach) expands the possibility of PAP assessment, especially at exercise when TRV feasibility is the lowest but correlation with invasive PAP seems to increase.

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2.DECELERATION TIME OF THE LEFT VENTRICULAR OUTFLOW TRACT FLOW VELOCITY: A SURROGATE DOPPLER ECHOCARDIOGRAPHIC PARAMETER FOR CENTRAL PULSE PRESSURE

Artery Research ◽

10.1016/j.artres.2009.06.004 ◽

2009 ◽

Vol 3 (3) ◽

pp. 92

Author(s):

Chi Young Shim ◽

Sungha Park ◽

Woo-in Yang ◽

Sung-Ai Kim ◽

Sang-Jae Rhee ◽

...

Keyword(s):

Flow Velocity ◽

Pulse Pressure ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Echocardiographic Parameter ◽

Left Ventricular Outflow ◽

Central Pulse Pressure ◽

Deceleration Time

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An Ascending Aortic Haemodynamic Comparison Between Normotensive and Hypertensive Subjects

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2013/19816 ◽

2018 ◽

Vol 2 (1) ◽

pp. 16

Author(s):

Vijay Kumar Narayana ◽

Rajeev Sharma ◽

Niranjan Murthy

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Ejection Fraction ◽

Pressure Gradient ◽

Aortic Blood Flow ◽

Ejection Time ◽

Acceleration Time ◽

Aortic Blood ◽

Ascending Aortic Diameter ◽

Deceleration Time

Background: Systemic hypertension, a common disorder with potentially serious complications, exerts ill effects through structural and functional modifications of arterial wall. Haemodynamics play an important role in the development of atherosclerosis. Local hemodynamic temporal pressure and wall shear stress are important for understanding the mechanisms leading to various complications in cardiovascular function.Objectives: Since we could not find such a study in literature involving Indian population, this prompted us to investigate and establish the relationship between the blood pressure and the ascending aortic pulse wave parameters in normal individuals and compare the same with hypertensives.Material and Methods: A case control study was done in a tertiary care hospital involving 25 hypertensive parents and further compared with 25 normotensive subjects of same age group acting as control. The GE ̶ P 100 Doppler echocardiography machine was used to study acceleration time, deceleration time, ejection time, ejection fraction, peak flow velocity and pressure gradient in hypertensives and compared the same with age matched normotensive. Also ascending aortic diameter was mapped at the annulus.Results: The results of our study confirmed our assumption that in hypertensive the ascending aortic haemodynamic parameters are abnormal and both systolic and diastolic blood pressure does exert a statistically significant influence on the Doppler parameters of ascending aorta. The acceleration time, deceleration time, pressure gradient and ejection time showed statistically significant increase in hypertensives when compared to normotensive. At the same time the ejection fraction and the ascending aortic diameter showed a statistically significant decrease than normotensive.Conclusion: We would conclude to say that the Doppler parameters of ascending aortic blood flow are abnormal in hypertensives. This altered haemodynamics may lead to further ill effects by way of altered peripheral haemodynamics. This Doppler evaluation of ascending aortic blood flow can be developed as a clinical tool for evaluating hypertensives and assessing the benefit of treatment of hypertension.

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EXERCISE AORTIC FLOW ACCELERATION AND VO?me?

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-198004001-00017 ◽

1980 ◽

Vol 21 (Supplement) ◽

pp. S3

Author(s):

Thomas G. Cagle ◽

Stephen A. Altobelli ◽

Thomas W. Chick

Keyword(s):

Aortic Flow ◽

Flow Acceleration

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Evaluation of Left Ventricular Outflow Gradients During Staged Exercise Stress Echocardiography Helps Differentiate Pediatric Patients With Hypertrophic Cardiomyopathy From Athletes and Normal Subjects

Pediatric Exercise Science ◽

10.1123/pes.2020-0217 ◽

2021 ◽

pp. 1-7

Author(s):

Mansi Gaitonde ◽

Shannon Jones ◽

Courtney McCracken ◽

Matthew E. Ferguson ◽

Erik Michelfelder ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Ventricular ◽

Exercise Stress ◽

Peak Exercise ◽

Acceleration Time ◽

Left Ventricular Outflow ◽

Stage 1 ◽

Normal Controls ◽

Peak Gradient ◽

Deceleration Time

Background: Elevated left ventricular outflow tract (LVOT) gradients during exercise can occur in patients with hypertrophic cardiomyopathy (HCM) as well as in athletes and normal controls. The authors’ staged exercise protocol calls for imaging at rest and during each stage of exercise to evaluate the mechanism of LVOT obstruction at each stage. They investigated whether this staged approach helps differentiate HCM from athletes and normal controls. Methods: They reviewed pediatric exercise stress echocardiograms completed between January 2009 and October 2017 at their center and identified those with gene-positive HCM, athlete’s heart, and normal controls. Children with inducible obstruction (those with no LVOT gradient at rest who developed a LVOT peak gradient > 25 mm Hg during exercise) were included. LVOT peak gradient, velocity time integral, acceleration time, and deceleration time were measured at rest, submaximal stages, and peak exercise. Results: Compared with athletes, HCM patients had significantly higher LVOT peak gradients at rest (P = .019), stage 1 of exercise (P = .002), and peak exercise (P = .051), as well as a significantly higher change in LVOT peak gradient from rest to stage 1 (P = .016) and from rest to peak (P = .038). The acceleration time/deceleration time ratio of the LVOT Doppler was significantly lower in HCM patients compared with normal controls at peak exercise. Conclusions: The HCM patients who develop elevated LVOT gradients at peak exercise typically manifest early obstruction in the submaximal stages of exercise, which helps to differentiate them from athletes and normal controls.

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Correlation of Peak Aortic and Carotid Flow Acceleration during Coronary Occlusion in Conscious Baboons

Clinical Science ◽

10.1042/cs0480243 ◽

1975 ◽

Vol 48 (4) ◽

pp. 243-246

Author(s):

J. E. Chimoskey ◽

W. J. Flanagan ◽

L. L. Huntsman ◽

E. Gams ◽

R. F. Rushmer

Keyword(s):

Coronary Occlusion ◽

Myocardial Function ◽

Peak Flow ◽

Aortic Flow ◽

Indirect Measure ◽

Flow Acceleration ◽

Acute Coronary Occlusion ◽

The Common ◽

Peak Blood ◽

Carotid Flow

1. Peak blood flow acceleration measured in the common carotid artery was compared with peak flow acceleration measured in the ascending aorta of three baboons. 2. The response to occlusion for 60 s of the circumflex branch or the anterior descending branch of the left coronary artery was investigated. 3. Both accelerations decreased approximately to the same extent. Peak aortic flow velocity, stroke volume and cardiac output also decreased but to a smaller extent. 4. It is concluded that peak aortic flow acceleration is a sensitive index of myocardial function during acute coronary occlusion in conscious primates and that peak carotid flow acceleration is an indirect measure of myocardial performance under the same conditions.

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Effect of inhaled procaterol and budesonide on right ventricular diastolic function in children with asthma

Paediatrica Indonesiana ◽

10.14238/pi49.3.2009.131-4 ◽

2009 ◽

Vol 49 (3) ◽

pp. 131

Author(s):

Alit Utamayasa ◽

Najib Advani ◽

Imam Boediman ◽

Sudigdo Sastroasmoro ◽

Bambang Madiyono

Keyword(s):

Right Ventricular ◽

Diastolic Function ◽

Ventricular Diastolic Function ◽

Acceleration Time ◽

Before And After ◽

Children With Asthma ◽

Right Ventricular Diastolic Function ◽

Paired T Test ◽

Diastolic Functions ◽

Deceleration Time

Objectives To study changes in parameters of right ventricular(RV) diastolic function after procaterol and budesonide inhalationin children with asthma.Methods This was a one-group pretest-posttest design to determinechanges in right ventricular diastolic function followingfour weeks of inhaled procaterol and budesonide administration.Subjects were children aged 8 to 18 years with frequent episodicasthma recruited consecutively at the Department of ChildHealth, Cipto Mangunkusumo Hospital. M-mode and 2-Dechocardiography examinations were performed to determine RVisovolumetric relaxation time (IVRT), acceleration time (AT),deceleration time (DT), E wave, A wave, E/ A ratio, and tricuspidannular plane systolic excursion (TAPSE). Means of the RVfunction parameters before and after treatment were comparedusing the paired t-test or Wilcoxon test.Results There were 29 patients comprising 16 boys and 13 girls. Themeans or medians of theE wave, A wave, E/A ratio, accelerationtime (AT), deceleration time (DT), and isovolumetric relaxationtime (IVRT) before and after treatment were 0.55 and 0.55 em/sec(P=0.709), 0.45 and 0.35 em/sec (P<O.OOOl), 1.17 and 1.58 em/sec(P<0.0001), 52.73 and 55.03 m/sec (P=0.04), 55.39 and 58.10 m/sec (P=0.03), and 46.50 and 70.0 m/sec (P<0.0001), respectively.The median pre- and post-inhalation TAPSE were 1.63 and 1.84em, respectively (P<0.001).Conclusions In children with frequent episodic asthma, thereare changes in RV diastolic functions IVRT, AT, DT, E/A ratioand A wave following procaterol and budesonide inhalation.There was no increase in E wave following inhalation. TAPSEwas increased following procaterol and budesonide inhalation.

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