scholarly journals Flow Acceleration Time and Ratio of Acceleration Time to Ejection Time for Prosthetic Aortic Valve Function

2011 ◽  
Vol 4 (11) ◽  
pp. 1161-1170 ◽  
Author(s):  
Sagit Ben Zekry ◽  
Robert M. Saad ◽  
Mehmet Özkan ◽  
Maie S. Al Shahid ◽  
Mauro Pepi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Time ◽  
Acceleration Time ◽  
Flow Acceleration ◽  
Prosthetic Aortic Valve ◽  
Valve Function

Abstract 6139: Flow Acceleration Time: A Novel Diagnostic Parameter for Prosthetic Aortic Valve Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sagit Ben Zekry ◽  
Robert M Saad ◽  
Stephen H Little ◽  
William A Zoghbi
Keyword(s):  
Aortic Valve ◽  
Characteristic Curve ◽  
Effective Orifice Area ◽  
List Type ◽  
Ejection Time ◽  
Acceleration Time ◽  
Flow Acceleration ◽  
Prosthetic Aortic Valve ◽  
Patient Prosthesis Mismatch ◽  
Echocardiographic Parameters

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.

scholarly journals Ratio of Acceleration Time to Ejection Time of Transaortic Jet in Aortic Stenosis Depends on Acoustic Window

2021 ◽  
Author(s):  
Takuya Sasaki ◽  
Kenta Kunimutsu ◽  
Nobuaki Tanaka ◽  
Mayu Nakamoto ◽  
Ayano Fujii ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Pressure Gradient ◽  
Aortic Valve Area ◽  
Ejection Time ◽  
Acoustic Window ◽  
Acceleration Time ◽  
Mean Pressure ◽  
Continuous Doppler ◽  
Valve Area

Background: Echocardiographic transaortic jet velocity (Vmax), mean pressure gradient (mPG), and aortic valve area (AVA) are routinely measured for severity of aortic stenosis (AS). Additionally, prolonged ejection time (ET), acceleration time (AT), and its ratio AT/ET are also known as indexes of AS severity. However, acoustic window dependency of AT/ET is not well studied. Methods: Eighty-one patients with AS assessed by transaortic jet tracing of all of three approaches (apical 3-chamber (3C), apical 5-chamber (5C), and right parasternal (R)) were included in this study. ET, AT, and AT/ET were measured on continuous Doppler recordings obtained by 3C, 5C, and R approaches. Also, ET and AT were corrected by dividing by (R-R interval)1/2, and they were named as cET and cAT. Results: No differences were observed in cET among 3 approaches. However, cAT was significantly longer in R (115+23 msec: p<0.05) compared to that of 3C (105+21 msec) or 5C (105+20 msec). AT/ET was significantly greater in R (0.340+0.058, p<0.05) compared to that of 3C (0.317+0.053) or 5C (0.316+0.055). AT/ET-peak V relation of R approach positioned significantly upward (ANCOVA, p<0.05) comparing to that of 3C or 5C. Also, AT/ET-AVAi relation of R approach positioned upward (ANCOVA, p<0.05) comparing to that of 3C or 5C. Conclusions: AT/ET by R approach was greater than that by 3C or 5C approach. Although multiple acoustic window’s approaches including R is recommended to obtain the maximal Vmax or mPG, AT/ET is better in 3C or 5C approach than R when AT/ET is used for AS severity.

scholarly journals Ejection dynamics in native aortic valve stenosis using echocardiography: can it be helpful?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Bawor ◽  
K Gu ◽  
K Um ◽  
B Dennis ◽  
D Leong
Keyword(s):  
Systematic Review ◽  
Aortic Valve ◽  
Diagnostic Accuracy ◽  
Aortic Valve Stenosis ◽  
Doppler Echocardiography ◽  
Outcome Measurement ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Ejection Time ◽  
Acceleration Time

Abstract Background The assessment of aortic stenosis (AS) severity has a major impact on the management of affected patients. Ejection dynamics, including acceleration time (AT), ejection time (ET), and acceleration time/ejection time ratio (AT/ET) measured using doppler echocardiography are established in the evaluation of prosthetic aortic valve stenosis with high sensitivity and specificity. However, their clinical utility in native AS has not been well described. Purpose The aim of this systematic review was to evaluate the diagnostic accuracy of ejection dynamics to identify severe AS and to assess whether ejection dynamics can differentiate low flow, low gradient severe AS from pseudo-severe AS. Methods We conducted a systematic review of Medline, Embase, and Web of Science from database inception until January 2021. We included observational studies and randomized controlled trials (RCTs) in which the diagnostic accuracy of ejection dynamics by doppler echocardiography for severe AS was compared with standard echocardiographic diagnostic criteria including peak velocity, mean pressure gradient, aortic valve area, and dimensionless index. Studies were eligible if they included AS of at least mild severity. Two authors independently screened and extracted data. Results We included 12 studies in the review (RCT=1, observational=11) with a total of 5182 participants. There was significant inconsistency in outcome measurement and reporting of results therefore a meta-analysis was not suitable. We used narrative synthesis to report our results. All included studies used standard echocardiographic criteria to ascertain the presence of severe AS. Mean age was 72 years and 53% of the participants were male. 1983 participants (38.3%) were classified as having severe AS. AT &gt;94–109ms had sensitivity of 74–92% and specificity of 72–89% at identifying severe AS. AT/ET &gt;0.34–0.35 showed sensitivity of 67–77% and specificity of 68–100%. Only one study compared low-flow, low-gradient AS with pseudo-severe AS, showing that an AT &gt;100ms had sensitivity 62%, specificity 76%; and AT/ET &gt;0.33, sensitivity 65%, specificity 84%. Data for ET showed insufficient consistency and diagnostic accuracy. Conclusions AT and AT/ET may be useful to corroborate the presence of severe AS. However, more research is needed to understand whether these parameters add incremental prognostic value to standard echocardiographic measures of AS severity. FUNDunding Acknowledgement Type of funding sources: None. Summary of evidence search and selection

P3696Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Altes ◽  
M Sochala ◽  
D Attias ◽  
J Dreyfus ◽  
M Toledano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Multivariate Linear Regression Analysis ◽  
Aortic Valve Area ◽  
Ejection Time ◽  
Acceleration Time

Abstract 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. Acknowledgement/Funding Local funding

Doppler Echocardiographic Assessment of Prosthetic Aortic Valve Function

CHEST Journal ◽  
1991 ◽  
Vol 99 (2) ◽  
pp. 399-403 ◽  
Author(s):  
Toshiji Iwasaka ◽  
Charles Z. Naggar ◽  
Tetsuro Sugiura ◽  
Noritaka Tarumi ◽  
Yasuo Takayama ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Prosthetic Aortic Valve ◽  
Valve Function ◽  
Echocardiographic Assessment

Outcome of Pulmonary Autograft After the Ross Procedure

2021 ◽  
Vol 12 (4) ◽  
pp. 508-515 ◽  
Author(s):  
Yuki Nakayama ◽  
Takeshi Shinkawa ◽  
Goki Matsumura ◽  
Ryogo Hoki ◽  
Kei Kobayashi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hospital Discharge ◽  
Mechanical Valve ◽  
Good Health ◽  
Hospital Death ◽  
Ross Procedure ◽  
Prosthetic Aortic Valve ◽  
Related Risk ◽  
Combined Lesions

Background: The purpose of this study was to assess autograft function after the Ross procedure and to review surgical outcomes associated with autograft reoperations. Methods: This is a retrospective study of patients undergoing the Ross procedure since 1993. Autograft function and autograft reoperation were studied. Autograft failure was defined as more than moderate autograft regurgitation or autograft dilatation to more than 50 mm diameter or z-score of more than +4 in children. One hospital death was excluded from analysis as were patients with unknown late autograft status. Results: Among 75 patients analyzed, preoperative diagnosis before the Ross procedure included aortic regurgitation in 26, aortic stenosis in 19, combined lesions in 28, and 2 mechanical valve malfunctions. Median age at the Ross procedure was 12.1 (0.4-43.6) years with 44 children less than 15 years old. Six patients had greater than mild autograft regurgitation at post-Ross hospital discharge. During median follow-up of 14.9 years, there were 23 autograft failures. Eighteen autograft reoperations were performed on 17 patients (13 children), including 12 aortic valve replacements, 5 aortic root replacements (including 1 valve-sparing root replacement), and 1 Konno procedure. Freedom from autograft failure and autograft reoperation at 20 years after the Ross procedure was 52.0% and 66.3%, respectively. Multivariate analysis identified greater than mild autograft regurgitation at hospital discharge from Ross procedure as a risk factor for autograft failure ( P < .01). All patients who underwent autograft reoperation survived and had good health status at a median of 6.9 years after the reoperation. Conclusions: The Ross procedure is effective in delaying prosthetic aortic valve replacement, although the time-related risk of autograft failure is a real consideration.

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