Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function

Sagit Ben Zekry, Robert M. Saad, Mehmet Zkan, Maie S. Al Shahid, Mauro Pepi, Manuela Muratori, Jiaqiong Xu, Stephen H. Little, William A. Zoghbi

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives: We sought to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), can differentiate prosthetic aortic valve (PAV) stenosis from controls and prosthesispatient mismatch (PPM). Background: Diagnosing PAV stenosis, especially in mechanical valves, may be challenging and has significant clinical implications. Methods: Doppler echocardiography was quantitated in 88 patients with PAV (44 mechanical and 44 bioprosthetic; age 63 ± 16 years; valve size range 18 to 25 mm) of whom 22 patients had documented PAV stenosis, 22 had PPM, and 44 served as controls. Quantitative Doppler parameters included ejection dynamics (AT, ET, and AT/ET) and conventional PAV parameters. Results: Patients with PAV stenosis had significantly lower effective orifice area (EOA) values and higher gradients compared with controls and PPM. Flow ejection parameters (AT and AT/ET) were significantly longer in the stenotic valves compared with PPM and controls (respective values for AT: 120 ± 24 ms, 89 ± 16 ms, and 71 ± 15 ms; for AT/ET: 0.4, 0.32, and 0.3, p ≤ 0.001). Patients with PPM had gradients and ejection dynamics that were intermediate between normal and stenotic valves. Receiver-operator characteristic (ROC) curve analysis showed that AT and AT/ET discriminated PAV stenosis from PPM and controls (area under ROC curve = 0.92 and 0.88, respectively). Combining AT with the conventional Doppler velocity index gave the highest area under the curve of 0.98 but was not statistically different from that of AT alone (p = 0.12). A cutoff of AT = 100 ms had a sensitivity and specificity of 86% for identifying PAV stenosis; for an AT/ET = 0.37, the sensitivity and specificity were 96% and 82%, respectively. Analysis by valve type (mechanical and biological) revealed similar results; however, biological valves had slightly higher areas under the curve for all systolic time intervals. Conclusions: Ejection dynamics through PAV, particularly AT and AT/ET, are reliable angle-independent parameters that can help evaluate valve function and identify PAV stenosis.

Original languageEnglish
Pages (from-to)1161-1170
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume4
Issue number11
DOIs
Publication statusPublished - Nov 2011

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Aortic Valve
Aortic Valve Stenosis
Area Under Curve
Sensitivity and Specificity
Doppler Echocardiography
Systole

Keywords

  • aortic stenosis
  • aortic valve
  • Doppler echocardiography
  • ejection parameters
  • prosthetic valve dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. / Ben Zekry, Sagit; Saad, Robert M.; Zkan, Mehmet; Al Shahid, Maie S.; Pepi, Mauro; Muratori, Manuela; Xu, Jiaqiong; Little, Stephen H.; Zoghbi, William A.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 11, 11.2011, p. 1161-1170.

Research output: Contribution to journalArticle

Ben Zekry, Sagit ; Saad, Robert M. ; Zkan, Mehmet ; Al Shahid, Maie S. ; Pepi, Mauro ; Muratori, Manuela ; Xu, Jiaqiong ; Little, Stephen H. ; Zoghbi, William A. / Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. In: JACC: Cardiovascular Imaging. 2011 ; Vol. 4, No. 11. pp. 1161-1170.
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abstract = "Objectives: We sought to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), can differentiate prosthetic aortic valve (PAV) stenosis from controls and prosthesispatient mismatch (PPM). Background: Diagnosing PAV stenosis, especially in mechanical valves, may be challenging and has significant clinical implications. Methods: Doppler echocardiography was quantitated in 88 patients with PAV (44 mechanical and 44 bioprosthetic; age 63 ± 16 years; valve size range 18 to 25 mm) of whom 22 patients had documented PAV stenosis, 22 had PPM, and 44 served as controls. Quantitative Doppler parameters included ejection dynamics (AT, ET, and AT/ET) and conventional PAV parameters. Results: Patients with PAV stenosis had significantly lower effective orifice area (EOA) values and higher gradients compared with controls and PPM. Flow ejection parameters (AT and AT/ET) were significantly longer in the stenotic valves compared with PPM and controls (respective values for AT: 120 ± 24 ms, 89 ± 16 ms, and 71 ± 15 ms; for AT/ET: 0.4, 0.32, and 0.3, p ≤ 0.001). Patients with PPM had gradients and ejection dynamics that were intermediate between normal and stenotic valves. Receiver-operator characteristic (ROC) curve analysis showed that AT and AT/ET discriminated PAV stenosis from PPM and controls (area under ROC curve = 0.92 and 0.88, respectively). Combining AT with the conventional Doppler velocity index gave the highest area under the curve of 0.98 but was not statistically different from that of AT alone (p = 0.12). A cutoff of AT = 100 ms had a sensitivity and specificity of 86{\%} for identifying PAV stenosis; for an AT/ET = 0.37, the sensitivity and specificity were 96{\%} and 82{\%}, respectively. Analysis by valve type (mechanical and biological) revealed similar results; however, biological valves had slightly higher areas under the curve for all systolic time intervals. Conclusions: Ejection dynamics through PAV, particularly AT and AT/ET, are reliable angle-independent parameters that can help evaluate valve function and identify PAV stenosis.",
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AU - Ben Zekry, Sagit

AU - Saad, Robert M.

AU - Zkan, Mehmet

AU - Al Shahid, Maie S.

AU - Pepi, Mauro

AU - Muratori, Manuela

AU - Xu, Jiaqiong

AU - Little, Stephen H.

AU - Zoghbi, William A.

PY - 2011/11

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N2 - Objectives: We sought to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), can differentiate prosthetic aortic valve (PAV) stenosis from controls and prosthesispatient mismatch (PPM). Background: Diagnosing PAV stenosis, especially in mechanical valves, may be challenging and has significant clinical implications. Methods: Doppler echocardiography was quantitated in 88 patients with PAV (44 mechanical and 44 bioprosthetic; age 63 ± 16 years; valve size range 18 to 25 mm) of whom 22 patients had documented PAV stenosis, 22 had PPM, and 44 served as controls. Quantitative Doppler parameters included ejection dynamics (AT, ET, and AT/ET) and conventional PAV parameters. Results: Patients with PAV stenosis had significantly lower effective orifice area (EOA) values and higher gradients compared with controls and PPM. Flow ejection parameters (AT and AT/ET) were significantly longer in the stenotic valves compared with PPM and controls (respective values for AT: 120 ± 24 ms, 89 ± 16 ms, and 71 ± 15 ms; for AT/ET: 0.4, 0.32, and 0.3, p ≤ 0.001). Patients with PPM had gradients and ejection dynamics that were intermediate between normal and stenotic valves. Receiver-operator characteristic (ROC) curve analysis showed that AT and AT/ET discriminated PAV stenosis from PPM and controls (area under ROC curve = 0.92 and 0.88, respectively). Combining AT with the conventional Doppler velocity index gave the highest area under the curve of 0.98 but was not statistically different from that of AT alone (p = 0.12). A cutoff of AT = 100 ms had a sensitivity and specificity of 86% for identifying PAV stenosis; for an AT/ET = 0.37, the sensitivity and specificity were 96% and 82%, respectively. Analysis by valve type (mechanical and biological) revealed similar results; however, biological valves had slightly higher areas under the curve for all systolic time intervals. Conclusions: Ejection dynamics through PAV, particularly AT and AT/ET, are reliable angle-independent parameters that can help evaluate valve function and identify PAV stenosis.

AB - Objectives: We sought to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), can differentiate prosthetic aortic valve (PAV) stenosis from controls and prosthesispatient mismatch (PPM). Background: Diagnosing PAV stenosis, especially in mechanical valves, may be challenging and has significant clinical implications. Methods: Doppler echocardiography was quantitated in 88 patients with PAV (44 mechanical and 44 bioprosthetic; age 63 ± 16 years; valve size range 18 to 25 mm) of whom 22 patients had documented PAV stenosis, 22 had PPM, and 44 served as controls. Quantitative Doppler parameters included ejection dynamics (AT, ET, and AT/ET) and conventional PAV parameters. Results: Patients with PAV stenosis had significantly lower effective orifice area (EOA) values and higher gradients compared with controls and PPM. Flow ejection parameters (AT and AT/ET) were significantly longer in the stenotic valves compared with PPM and controls (respective values for AT: 120 ± 24 ms, 89 ± 16 ms, and 71 ± 15 ms; for AT/ET: 0.4, 0.32, and 0.3, p ≤ 0.001). Patients with PPM had gradients and ejection dynamics that were intermediate between normal and stenotic valves. Receiver-operator characteristic (ROC) curve analysis showed that AT and AT/ET discriminated PAV stenosis from PPM and controls (area under ROC curve = 0.92 and 0.88, respectively). Combining AT with the conventional Doppler velocity index gave the highest area under the curve of 0.98 but was not statistically different from that of AT alone (p = 0.12). A cutoff of AT = 100 ms had a sensitivity and specificity of 86% for identifying PAV stenosis; for an AT/ET = 0.37, the sensitivity and specificity were 96% and 82%, respectively. Analysis by valve type (mechanical and biological) revealed similar results; however, biological valves had slightly higher areas under the curve for all systolic time intervals. Conclusions: Ejection dynamics through PAV, particularly AT and AT/ET, are reliable angle-independent parameters that can help evaluate valve function and identify PAV stenosis.

KW - aortic stenosis

KW - aortic valve

KW - Doppler echocardiography

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KW - prosthetic valve dysfunction

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