Evaluating ejection dynamic parameters for assessing severe aortic stenosis

Accurate diagnosis of aortic stenosis (AS) severity is crucial for effective treatment. This study aimed to define cutoff values for aortic ejection dynamic parameters, including ejection time (ET), acceleration time (AT), and the AT/ET ratio in patients with severe AS.

In both severe AS and control groups, the aortic valve area (AVA) was estimated using the continuity equation, and the trans-aortic mean pressure gradient (MPG) was measured using continuous-wave Doppler echocardiography. Blood flow time-velocity integral in the left ventricular outflow tract (LVOT TVI) was measured with pulsed-wave Doppler ultrasound, placing the sample volume 1 cm below the aortic valve. Severe AS was defined as AVA ≤1 cm² and MPG ≥ 40 mmHg. Clinical data were recorded, and 2D and Doppler echocardiography, including ejection dynamic parameters were analyzed.

AT with a cutoff of 73 ms demonstrated perfect accuracy in diagnosing severe AS, with both sensitivity and specificity of 100%. ET with a cutoff of 278 ms showed 90% sensitivity and 100% specificity for identifying severe AS. Additionally, the AT/ET ratio exhibited a positive relationship with MPG (r = 0.55, P = 0.001) and a negative relationship with AVA (r = -0.52, P = 0.003). The AT/ET ratio, using a cutoff value of 0.278, yielded a sensitivity of 96% and a specificity of 100% for diagnosing severe AS.

Aortic Doppler ejection dynamic parameters can serve as complementary assessment indices, diagnosing severe AS with acceptable accuracy.