Acceleration Time/Ejection Time Ratio Compared to Mean Gradient as a Predictor of Clinical Outcomes Post-TAVR

Transcatheter aortic valve replacement (TAVR) is a significant treatment option for patients with severe aortic stenosis. Aortic valve (AV) mean gradient (MG) is frequently used to assess prosthetic valve function. Although MG is a helpful measure of valve performance, it depends on cardiac output and pressure recovery, which can be important confounders.

The aims of this study were to explore TAVR valve hemodynamic status using the acceleration time (AT)/ejection time (ET) ratio and to compare AT/ET and MG correlations with post-TAVR clinical outcomes.

This retrospective cohort study involves patients >18 years of age undergoing TAVR between 2016 and 2020. AV AT/ET was measured within 3 months post-TAVR. A total of 1,900 patients were classified into 2 groups: those with AV AT/ET ≥ 0.35 and those with AV AT/ET < 0.35. Baseline characteristics, echocardiographic measurements, heart failure hospitalization (HFH), and mortality were assessed between the groups.

AT/ET ≥ 0.35 was associated with an increase in 1-year HFH (P < 0.001 at 1 year) and was not associated with mortality. Patients with AV MG >20 mm Hg had comparable 1-year HFH (P = 0.46 at 1 year) and mortality compared with those with AV MG <20 mm Hg. More patients with self-expanding valves (23.2%) had AT/ET ≥0.35 than those who received balloon-expandable valves (12.7%) (P = 0.001).

Post-TAVR AT/ET ≥0.35 can potentially predict clinical outcomes such as HFH. AT/ET may explain the discrepancy between self-expanding and balloon-expandable valves in measured hemodynamic status and outcomes.