Background

Ejection dynamics parameters are useful in assessing prosthetic valve obstruction, but very limited data are available in the setting of native aortic stenosis (AS). The aim of this study was to evaluate and compare the prognostic value of acceleration time (AT) and the ratio of AT to ejection time (ET) in patients with AS.

Methods

AT and AT/ET were prospectively measured in 456 patients with AS (aortic valve area < 1.3 cm²; mean aortic valve area, 0.85 ± 0.24 cm²). The relationships between AT/ET, AT, and mortality during follow-up were studied.

Results

During a median follow-up period of 35 months (interquartile range, 33–37 months), 124 patients died. After adjustment for variables of prognostic importance, including mean pressure gradient, stroke volume index, and aortic valve replacement as a time-dependent covariate, patients in the highest tertiles of both AT/ET (>0.36) and AT (>112 msec) were at high risk for overall mortality (adjusted hazard ratios, 2.44 [95% CI, 1.46–4.08; P = .001] and 1.78 [95% CI, 1.06–2.98; P = .029], respectively) compared with those in the lowest tertiles of AT/ET and AT, while survival was similar for the other tertiles (P = NS for all). Compared with patients with AT/ET ≤ 0.36, an increased risk for overall mortality was observed in patients with AT/ET > 0.36 (adjusted hazard ratio, 2.51; 95% CI, 1.66–3.78; P < .0001), while the risk for mortality was not significantly increased in patients with AT > 112 msec compared with those with AT ≤ 112 msec. Adding AT/ET > 0.36 to a multivariate model including classical variables of prognostic importance, including mean pressure gradient and stroke volume index, improved predictive performance in terms of overall mortality, with improved global model fit, reclassification, and better discrimination.

Conclusions

Among ejection dynamics parameters in patients with AS, AT/ET is strongly associated with excess risk for death during follow-up. AT/ET should be considered in the multiparametric echocardiographic prognostic assessment of patients with AS in clinical practice.

中文翻译：

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主动脉瓣狭窄患者射血动力学参数的临床意义：一项结局研究

背景

射血动力学参数可用于评估人工瓣膜梗阻，但在自然主动脉瓣狭窄（AS）的情况下，可获得的数据非常有限。这项研究的目的是评估和比较AS患者的加速时间（AT）和AT与射血时间（ET）之比的预后价值。

方法

前瞻性测量456例AS患者（主动脉瓣面积<1.3 cm ²；平均主动脉瓣面积0.85±0.24 cm ²）。研究了随访期间AT / ET，AT与死亡率之间的关系。

结果

在35个月的中位随访期间（四分位间距为33-37个月），有124例患者死亡。在调整了对预后重要性的变量（包括平均压力梯度，中风量指数和主动脉瓣置换作为时间相关协变量）后，AT / ET（> 0.36）和AT（> 112 msec）最高三分位数的患者总体死亡率较高（调整后的危险比，分别为2.44 [95％CI，1.46-4.08；P  = .001]和1.78 [95％CI，1.06-2.98；P  = .029]）。 AT / ET和AT的最低三分位数，而其他三分位数的生存率相似（P =全部为NS）。与AT / ET≤0.36的患者相比，AT / ET> 0.36的患者总体死亡率风险增加（调整后的危险比为2.51； 95％CI为1.66–3.78；P  <.0001），与AT≤112毫秒的患者相比，AT> 112毫秒的患者的死亡率没有显着增加。将AT / ET> 0.36添加到一个多变量模型中，该模型包括具有预后重要性的经典变量，包括平均压力梯度和中风量指数，在总体死亡率方面改善了预测性能，同时改善了整体模型拟合，重新分类和更好的区分度。

结论

在AS患者的射血动力学参数中，AT / ET与随访期间死亡的额外风险密切相关。在临床实践中，对AS患者进行多参数超声心动图预后评估时应考虑AT / ET。