Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis ( JIMG November 2024)-Article: Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis

Article: Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis

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This study investigates the use of the acceleration-to-ejection time ratio (AT:ET) to predict outcomes and guide the decision for aortic valve replacement (AVR) in patients with paradoxical low-flow low-gradient aortic stenosis (PLFAS). PLFAS poses a clinical challenge due to its heterogeneous nature, complicating the assessment of true stenosis severity. Traditional measures show conflicting survival benefits from AVR in such cases, necessitating additional parameters for improved patient selection.<br /><br />The research included 171 PLFAS patients divided based on an AT:ET cutoff of 0.35, following them for a median of 8.9 years. The study found that an AT:ET greater than 0.35 independently predicted worse outcomes, including a higher risk of cardiac death or need for AVR. Patients with an AT:ET of 0.35 who underwent AVR showed a marked reduction in 5-year cardiac and all-cause mortality, suggesting substantial benefits from the procedure in this subgroup. Conversely, those with an AT:ET of less than 0.35 did not demonstrate improved survival from AVR.<br /><br />AT:ET may thus be seen as a practical echocardiographic tool that can offer incremental value to standard assessments, potentially allowing for more tailored and effective management of PLFAS patients who might benefit from AVR. With a C-statistic showing strong predictive capability, AT:ET offers added insights beyond conventional measures like stroke volume index (SVI) and aortic valve area (AVA).<br /><br />The study’s results highlight AT:ET's potential in enhancing prognostic evaluations and treatment pathways for PLFAS, suggesting further prospective research to solidify its role in assessing stenosis severity and determining AVR candidacy. Additionally, this diagnostic metric provides an opportunity to better navigate the complexity of PLFAS, ensuring appropriate intervention strategies and improved patient outcomes.

Keywords

acceleration-to-ejection time ratio

aortic valve replacement

paradoxical low-flow low-gradient aortic stenosis

PLFAS

echocardiographic tool

cardiac outcomes

AVR candidacy

prognostic evaluations

stenosis severity

patient management