Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Paradoxical low-flow low-gradient aortic stenosis (PLFAS) presents diagnostic challenges due to heterogeneous patient populations and uncertain stenosis severity.
• Outcomes following aortic valve replacement (AVR) in PLFAS patients are variable, complicating clinical decision-making.

Purpose of the Study:

• To evaluate the acceleration (AT) to ejection (ET) time ratio (AT:ET) as a prognostic marker in undifferentiated PLFAS.
• To determine the utility of AT:ET for predicting the benefit of AVR in PLFAS patients.

Main Methods:

• Echocardiographic data from 171 PLFAS patients were analyzed, defining PLFAS by specific aortic valve area, gradient, stroke volume, and ejection fraction criteria.
• Patients were stratified based on an AT:ET ratio cutoff of 0.35.
• The primary outcome was a composite of 5-year cardiac mortality or AVR, with secondary outcomes including all-cause mortality and individual endpoint components. The impact of AVR was assessed within AT:ET subgroups.

Main Results:

• An AT:ET ratio ≥0.35 independently predicted the primary outcome (cardiac mortality or AVR) and was associated with increased cardiac death and need for AVR.
• The AT:ET ratio demonstrated incremental prognostic value over standard stenosis severity indices.
• Aortic valve replacement in patients with AT:ET ≥0.35 was linked to substantial reductions in 5-year cardiac and all-cause mortality, whereas AVR offered no survival benefit in the AT:ET <0.35 group.

Conclusions:

• An AT:ET ratio ≥0.35 identifies PLFAS patients with poorer prognosis and a higher likelihood of requiring AVR.
• The AT:ET ratio shows potential as a valuable tool for optimizing patient selection for prognostic AVR in PLFAS.