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Isovolumic contraction time by pulsed-wave Doppler tissue imaging in aortic stenosis
R Moreno1, J Zamorano, C Almería
1Laboratory of Echocardiography, Hospital Clinico San Carlos, Madrid, Spain. raulmorenog@terra.es
Insights
Isovolumic contraction time (ICT) measured by Doppler Tissue Imaging (DTI) is prolonged in patients with severe aortic stenosis (AS). This finding suggests ICT may be a useful diagnostic marker for assessing AS severity.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Doppler Tissue Imaging (DTI) is used in heart disease evaluation.
- Left ventricular contraction is slowed in patients with aortic stenosis (AS).
Purpose of the Study:
- To evaluate the role of isovolumic contraction time (ICT) measured by DTI in assessing AS severity.
Main Methods:
- 30 patients (15 AS, 15 controls) with normal systolic function were studied.
- ICT was measured from QRS onset to the DTI systolic wave.
- Correlation between ICT and aortic area was assessed.
Main Results:
- ICT was significantly increased in severe AS patients (98±27 ms) compared to controls (65±21 ms).
- A significant inverse correlation was found between ICT and aortic area (r=-0.56, p=0.035).
- Receiver operator characteristic curve analysis showed an area under the curve of 0.852 for ICT in identifying severe AS.
Conclusions:
- Isovolumic contraction time (ICT) measured by pulsed-wave DTI is increased in patients with aortic stenosis.
- ICT may serve as a valuable non-invasive marker for evaluating AS severity.
Background:
Doppler Tissue Imaging (DTI) has been evaluated in ischaemic heart disease and some cardiomyopathies. In patients with aortic stenosis (AS), left ventricular contraction is slowered. This study aimed to evaluate the possible role of the measurement of isovolumic contraction time (ICT) by DTI in the evaluation of AS severity.
Methods:
The study population constitutes 30 patients: 15 with AS (nine severe and six non-severe) and 15 control subjects. All of them had normal systolic function, sinus rhythm, and absence of ischaemic heart disease of conduction abnormalities. ICT was defined as the time from the onset of the QRS complex to the beginning of the DTI systolic wave. The correlation between ICT and aortic area obtained by continuity equation, as well as the diagnostic value of ICT in the identification of severe AS were studied.
Results:
ICT was significantly increased in patients with severe AS (98+/-27 versus 65+/-21 ms, p=0.024). There was a significant correlation between ICT and aortic area (r=-0.56; p=0.035). The receiver operator characteristic curve of ICT in the identification of severe AS yielded an area under the curve of 0.852 (95% confidence interval: 0.665-1.0). The two best cut-points were >73 ms (88% sensitivity, 77% specificity) and >85 ms (78% sensitivity, 83% specificity). A value of >41 ms had a 100% sensitivity, but only a 17% specificity, and >91 ms showed a 100% specificity, but only a 44% sensitivity.
Conclusions:
ICT measured by pulsed-wave DTI is increased in patients with aortic stenosis.
