Higher Acceleration/Ejection Time Ratio Predicts Impaired Ou
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Among patients with asymptomatic aortic valve stenosis (AS), elevated acceleration time(AT)/ejection time (ET) ratio was associated with increased cardiovascular (CV) mortality and morbidity, according to research.

The study was based on asymptomatic patients with presumably mild-moderate AS, normal ejection fraction, and without known diabetes or cardiovascular disease. A total of 1530 patients (38% women; mean age, 67 years)were included to explore the association of increased AT/ET ratio on prognosis.

Patients were part of the Simvastatin Ezetimibe Aortic Stenosis (SEAS) study.

Researchers grouped patients according to optimal acceleration time/ejection time ratio threshold to predict CV death and HF hospitalization. Patients were identified as having low-gradient severe aortic valve stenosis if they had a combined valve area of 1 cm2 or less and mean gradient of less than 40 mm Hg.

Outcome was assessed in Cox regression analyses.

Higher AT/ET ratio was significantly associated with lower systolic blood pressure, lower left ventricular ejection fraction, lower stress-corrected mid-wall shortening, low flow, and with higher left ventricular mass and higher peak aortic jet velocity. For predicting incident cardiovascular mortality and heart failure hospitalization in the entire study population, AT/ET ratio greater than 0.32 afforded the optimal cut-off. AT/ET ratio greater than 0.32 had a 79% higher risk of cardiovascular death and heart failure hospitalization. In patients with low-gradient severe AS, AT/ET ratio greater than 0.32 was associated with a 2-fold higher risk of cardiovascular death and heart failure hospitalization.

The researchers wrote, “The present post hoc analysis within the prospective SEAS study is the first to document the prognostic significance of higher acceleration time/ejection time ratio in a large cohort of asymptomatic patients with presumably mild to moderate aortic valve stenosis.” “As recommended by the guidelines, aortic valve stenosis severity, and probably acceleration time/ejection time ratio, should be reassessed when systolic blood pressure is normalized.” they added. “However, antihypertensive treatment may often fail to normalize arterial compliance or blood pressure in elderly subjects despite appropriate treatment. An important finding is, therefore, that acceleration time/ejection time ratio greater than 0.32 among patients with low-gradient severe aortic valve stenosis seems to improve risk stratification independent of systolic blood pressure, low flow or hypertension. Consequently, aortic valve stenosis patients with hypertension and high acceleration time/ejection time ratio may be a particular high-risk group.”

Source:
https://www.ahajournals.org/doi/abs/10.1161/CIRCIMAGING.120.011467
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