Valvular & structural heart diseaseCohort study
Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis
- Cohort study
Authors' conclusion
AT:ET ≥0.35 in PLFAS predicts poorer outcomes and/or need for AVR.
Study context
- Population
- Patients with paradoxical low-flow low-gradient AS (PLFAS; AVA <1.0 cm² or indexed AVA <0.6 cm²/m², mean gradient <40 mm Hg, indexed stroke volume <35 mL/m², LVEF ≥50%)median follow-up 8.9 years
- Participants
- 171 patients
- Exposure
- Acceleration (AT):Ejection (ET) ≥0.35 vs AT:ET <0.35
- Outcome
- Composite of:
- Cardiac mortality
- AVR
- Follow-up
- 5 years
Main finding
Cardiac mortality or AVR
Hazard ratio
4.77
95% CI 2.94–7.75
P < 0.001
AT:ET ≥0.35 vs AT:ET <0.35
HR 4.77 (95% CI 2.94–7.75); P < 0.001
As reported in the abstract
- Net reclassification improvement over standard indices of stenosis severity
- 0.57 [95% CI: 0.14-0.84]
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Cardiac death · competing risk analysis | 2.91 (1.47–5.76) | P = 0.002 | |
| AVR · competing risk analysis | 8.45 (4.16–17.1) | P < 0.001 | |
| Effect of AVR on mortality, AT:ET ≥0.35 (subgroup) · 5 years — AVR vs AT:ET <0.35 · cardiac mortality | 0.09 (0.02–0.36) | P < 0.001 | |
| Effect of AVR on mortality, AT:ET ≥0.35 (subgroup) · 5 years — AVR vs AT:ET <0.35 · all-cause mortality | 0.16 (0.07–0.38) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
All-cause mortality
- No difference in all-cause mortality
Effect of aortic valve replacement (AVR) on survival, AT:ET <0.35 (subgroup)
- No improvement in survival from AVR
Original publication
Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis. JACC Cardiovasc Imaging. Published 14 August 2024. doi:10.1016/j.jcmg.2024.05.015
Summarised from the published abstract; every number is checked against it