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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

Published on: November 28, 2018

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Direct relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with

Sameh Yousef1, Andrea Amabile1, Chirag Ram1

  • 1Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA.

Journal of Cardiac Surgery
|November 15, 2022
PubMed

Insights

Aortic stenosis (AS) severity, measured by transvalvular flow velocity (Vmax), strongly correlates with mortality. Patients with Vmax at or above the 97.5th percentile may benefit from early intervention for AS.

Area of Science:

  • Cardiology
  • Echocardiography
  • Aortic Stenosis

Background:

  • Current guidelines recommend intervention for severe symptomatic aortic stenosis (AS).
  • Any degree of AS is associated with increased mortality risk.
  • The relationship between AS severity and patient outcomes requires further investigation.

Purpose of the Study:

  • To investigate the association between the degree of aortic stenosis (AS), defined by transvalvular flow velocity (Vmax), and patient morbidity and mortality.
  • To determine if Vmax thresholds can identify patients who may benefit from early intervention.

Main Methods:

  • Retrospective analysis of 37,131 medically managed patients (40-95 years) with Vmax measured by echocardiography (2013-2018).
  • Patients stratified into five groups (A-E) based on Vmax percentiles.
  • Comparison of patient characteristics, cardiac structural changes, end-organ disease, and mortality using statistical tests and Cox proportional hazards models.

Main Results:

  • A steady increase in age, cardiac structural changes, end-organ morbidities, and all-cause mortality was observed with increasing Vmax groups.
  • Compared to Group A, mortality risk increased significantly in Groups B (HR 1.3), C (HR 1.5), and D (HR 1.8).
  • Group E (Vmax ≥ 97.5th percentile) showed an exponential increase in mortality risk (HR 2.5).

Conclusions:

  • A direct, strong correlation exists between the degree of AS (Vmax) and cardiac structural changes and mortality.
  • Patients with Vmax ≥ 97.5th percentile (≥3.2 m/s) may benefit from early intervention.
  • Vmax is a valuable parameter for risk stratification in AS patients.
Abstract

Keywords:
aortic stenosisdiagnosisheart failuremortalitytreatment

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