title: Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity.
abstract: BACKGROUND
  Inconsistencies in the grading of aortic valve stenosis are frequent (24-38%). Guidelines highlight the waveform shape when discrepancies are present. Our aim was to evaluate the severity of aortic stenosis by the ratio of acceleration time to ejection time (AT/ET).
  
  
  METHODS
  Between January 2011 and January 2013, patients with at least moderate aortic stenosis (valve area < 1.5 cm(2) ) evaluated in our echocardiography laboratory were enrolled. Clinical data were recorded including symptoms attributable to aortic stenosis. Quantitative echocardiographic Doppler parameters as ejection dynamics (ejection time and acceleration time) and conventional parameters, and usual laboratory test including natriuretic peptides (NT-proBNP) were analyzed.
  
  
  RESULTS
  One hundred eight patients with aortic valve stenosis were recruited (mean age 77 ± 7 years; 57% women). Comorbidity of the patients was frequent: 85% hypertension, 59% diabetes, 31% chronic renal failure, 26% smokers, mean body mass index 30.0 ± 6.6 kg/m(2) . Ninety-six patients (90%) were symptomatic at the index visit. Using a cutoff of 0.35, AT/ET had a sensitivity of 77% and a specificity of 100% to discriminate symptomatic patients. Serum value of NT-proBNP was higher in patients with AT/ET > 0.35 (9885 ± 3111 vs. 2600 ± 1175, P < 0.001). This ratio showed a good correlation with indexed left ventricle mass (r = 0.60, P < 0.001), DVI (r = -0.56, P < 0.001), and AVA (r = -0.49, P < 0.001).
  
  
  CONCLUSIONS
  Ejection dynamics through aortic valve, particularly AT/ET ratio, is a useful tool for assessing aortic stenosis severity, with a good correlation with flow-independent parameters in aortic stenosis.
authors.affiliation: Department of Cardiology, Jerez Hospital, Cádiz, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Gamaza-Chulián
authors.affiliation: Department of Cardiology, Jerez Hospital, Cádiz, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Camacho-Freire
authors.affiliation: Department of Medicine, Cadiz University, Cádiz, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Toro-Cebada
authors.affiliation: Department of Cardiology, Jerez Hospital, Cádiz, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Giráldez-Valpuesta
authors.affiliation: Department of Cardiology, Jerez Hospital, Cádiz, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Benezet-Mazuecos
authors.affiliation: Department of Cardiology, Jerez Hospital, Cádiz, Spain.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Vargas-Machuca
mesh_terms: D000054:Acceleration; D000368:Aged; D000465:Algorithms; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Doppler echocardiography; aortic stenosis; aortic valve; ejection parameters