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

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.

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Reducing the Inconsistency between Doppler and Invasive Measurements of the Severity of Aortic Stenosis Using Aortic Valve Coefficient: A Retrospective Study on Humans

Journal of Computational Medicine ◽

10.1155/2014/419689 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Anup K. Paul ◽

Rupak K. Banerjee ◽

Arumugam Narayanan ◽

Mohamed A. Effat ◽

Jason J. Paquin

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Dynamic Pressure ◽

Clinical Parameter ◽

Aortic Valve Area ◽

Diagnostic Parameter ◽

Diagnostic Parameters ◽

Mean Pressure ◽

Marginal Improvement ◽

Valve Area

Background. It is not uncommon to observe inconsistencies in the diagnostic parameters derived from Doppler and catheterization measurements for assessing the severity of aortic stenosis (AS) which can result in suboptimal clinical decisions. In this pilot study, we investigate the possibility of improving the concordance between Doppler and catheter assessment of AS severity using the functional diagnostic parameter called aortic valve coefficient (AVC), defined as the ratio of the transvalvular pressure drop to the proximal dynamic pressure. Method and Results. AVC was calculated using diagnostic parameters obtained from retrospective chart reviews. AVC values were calculated independently from cardiac catheterization (AVCcatheter) and Doppler measurements (AVCdoppler). An improved significant correlation was observed between Doppler and catheter derived AVC (r=0.92, P<0.05) when compared to the correlation between Doppler and catheter measurements of mean pressure gradient (r=0.72, P<0.05) and aortic valve area (r=0.64, P<0.05). The correlation between Doppler and catheter derived AVC exhibited a marginal improvement over the correlation between Doppler and catheter derived aortic valve resistance (r=0.89, P<0.05). Conclusion. AVC is a refined clinical parameter that can improve the concordance between the noninvasive and invasive measures of the severity of aortic stenosis.

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LEFT ATRIAL DYSFUNCTION IN PATIENTS WITH PRESSURE GRADIENT-AORTIC VALVE AREA MISMATCHED SEVERE AORTIC STENOSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)61976-3 ◽

2015 ◽

Vol 65 (10) ◽

pp. A1976

Author(s):

Tomoko Tani ◽

Takeshi Kitai ◽

Kitae Kim ◽

Takafumi Yamane ◽

Atsushi Kobori ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Pressure Gradient ◽

Left Atrial ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

Left Atrial Dysfunction ◽

Valve Area

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

European Heart Journal ◽

10.1093/eurheartj/ehz745.0550 ◽

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

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Faculty Opinions recommendation of Outcome implication of aortic valve area normalized to body size in asymptomatic aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727057024.793527734 ◽

2017 ◽

Author(s):

Eric Brochet

Keyword(s):

Body Size ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Area ◽

Valve Area

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Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

European Heart Journal ◽

10.1093/ehjci/ehaa946.1934 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Piayda ◽

A Wimmer ◽

H Sievert ◽

K Hellhammer ◽

S Afzal ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Pressure Gradient ◽

Severe Aortic Stenosis ◽

Primary Treatment ◽

Low Flow ◽

Mean Pressure ◽

The Mean

Abstract Background In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure. Purpose To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS). Methods Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up. Results One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p<0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p<0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p<0.001). Conclusion In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192) Figure 1 Funding Acknowledgement Type of funding source: None

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P1692 The past returns after 20 years: a case report

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1055 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Habjan ◽

D Cantisani ◽

I S Scarfo` ◽

M C Guarneri ◽

G Semeraro ◽

...

Keyword(s):

Heart Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Valvular Heart Disease ◽

Radiation Treatment ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

Radiation Induced ◽

Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

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