Ratio of Acceleration Time to Ejection Time of Transaortic Jet in Aortic
Stenosis Depends on Acoustic Window
Abstract
Background: Echocardiographic transaortic jet velocity (Vmax), mean
pressure gradient (mPG), and aortic valve area (AVA) are routinely
measured for severity of aortic stenosis (AS). Additionally, prolonged
ejection time (ET), acceleration time (AT), and its ratio AT/ET are also
known as indexes of AS severity. However, acoustic window dependency of
AT/ET is not well studied. Methods: Eighty-one patients with AS assessed
by transaortic jet tracing of all of three approaches (apical 3-chamber
(3C), apical 5-chamber (5C), and right parasternal (R)) were included in
this study. ET, AT, and AT/ET were measured on continuous Doppler
recordings obtained by 3C, 5C, and R approaches. Also, ET and AT were
corrected by dividing by (R-R interval)1/2, and they were named as cET
and cAT. Results: No differences were observed in cET among 3
approaches. However, cAT was significantly longer in R (115+23 msec:
p<0.05) compared to that of 3C (105+21 msec) or 5C (105+20
msec). AT/ET was significantly greater in R (0.340+0.058,
p<0.05) compared to that of 3C (0.317+0.053) or 5C
(0.316+0.055). AT/ET-peak V relation of R approach positioned
significantly upward (ANCOVA, p<0.05) comparing to that of 3C
or 5C. Also, AT/ET-AVAi relation of R approach positioned upward
(ANCOVA, p<0.05) comparing to that of 3C or 5C. Conclusions:
AT/ET by R approach was greater than that by 3C or 5C approach. Although
multiple acoustic window’s approaches including R is recommended to
obtain the maximal Vmax or mPG, AT/ET is better in 3C or 5C approach
than R when AT/ET is used for AS severity.