Impact of ejection dynamics parameters on outcome in patients with aortic stenosis

Abstract

We sought to evaluate and compare both the prognostic value of acceleration time (AT) and the ratio of AT to ejection time (AT/ET) in aortic stenosis (AS). Ejection dynamics parameters are useful in assessing prosthetic valve obstruction but very limited data are available in the setting of native AS. AT and AT/ET were measured in a prospective cohort of patients with aortic stenosis (AVA < 1.3 cm 2 ). The relationships between AT/ET, AT, overall and cardiovascular mortality during follow-up were studied. Four hundred and fifty-six patients with AS (mean AVA 0.85 ± 0.24 cm 2 ) were included. After adjustment on variables of prognostic importance and on AVR as a time-dependent covariate, patients in the highest tertile of both AT/ET (> 0.36) and AT (> 112 ms) were at high risk of overall mortality (HR 2.57 [1.68–3.94] and HR 2.06 [1.33–3.18] respectively) and of cardiovascular mortality (HR 3.33[1.78–6.21] and HR 2.36[1.30–4.30] respectively), compared to patients in the lowest tertiles of AT/ET and AT, while the survival was similar for the other tertiles (all P values = NS). Compared to patients with an AT/ET≤ 0.36, an increased risk of overall and cardiovascular mortality was observed in patients with AT/ET > 0.36 (adjusted HR 2.55 [1.79–3.62] and adjusted HR 3.40 [2.05–5.64] respectively). Compared to patients with an AT≤ 112 ms, an increased risk of overall and cardiovascular mortality was observed in patients with AT > 112 ms (adjusted HR 1.75 [1.21–2.53] and adjusted HR 2.23[1.34–3.71] respectively). However, AT/ET showed better predictive performance than AT in terms of both overall and cardiovascular mortality with improved global model fit, reclassification, and better discrimination. Ejection dynamics parameters in AS, particularly AT/ET, are strongly associated with an excess risk of death during follow-up. AT/ET should be considered in the multi-parametric echocardiographic prognostic assessment of AS in clinical practice.