Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
Clin Res Cardiol. 2023 May;112(5):667-676. doi: 10.1007/s00392-023-02154-y. Epub 2023 Jan 19.
Ejection time (ET), acceleration time (AT) and time between left ventricular and aortic systolic pressure peaks (T-LVAo) might be of diagnostic and prognostic use in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
We aimed to assess the diagnostic value and prognostic impact of invasively measured ET, AT, and T-LVAo in patients undergoing TAVI.
A total of 1274 patients received invasive measurement of ET, AT and T-LVAo prior to TAVI. Anatomic AS severity was assessed by CT-derived aortic valve calcification density (AVC). Impact on all-cause mortality was retrospectively analyzed.
In multivariable linear regression, T-LVAo showed the strongest correlation with AVC. No prognostic impact of T-LVAo was found according to uni- and multivariable analyses. In contrast, using an individual C-statistic derived cutoff (C), patients with ET or AT ≥ C showed lower mortality rates compared to patients with ET or AT < C (1-year mortality: ET ≥ vs. < C: 15.01vs. 33.1%, AT ≥ vs < C 16.3 vs. 26.5%, p < 0.001). Moreover, multivariable analysis identified ET ≥ C (HR 0.61 [95% CI 0.43-0.87; p < 0.007]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters.
Among the studied hemodynamic parameters T-LVAo provides the highest diagnostic value, whereas ET is an outcome predictor beyond clinical risk factors and echocardiographic parameters in AS patients following TAVI. These parameters could be of considerable use in diagnostic evaluation and risk assessment of patients scheduled for TAVI. T-LVAo (yellow): defined as time between left ventricular and aortic systolic pressure peaks. ET (green): Ejection Time defined as time from the start to flow end. AT (orange): Acceleration time defined as time from the start to the peak flow. AOP: aortic pressure, AVC: aortic valve calcification, CI: confidence interval, HGAS: high-gradient aortic stenosis, LGAS: low-gradient aortic stenosis, LVP: left ventricular pressure, SD: standard deviation.
射血时间（ET）、加速度时间（AT）和左心室与主动脉收缩压峰值之间的时间（T-LVAo）在接受经导管主动脉瓣植入术（TAVI）的主动脉瓣狭窄（AS）患者中可能具有诊断和预后价值。
我们旨在评估 TAVI 前经导管测量的 ET、AT 和 T-LVAo 的诊断价值和预后影响。
共 1274 例患者接受了 ET、AT 和 T-LVAo 的侵入性测量。通过 CT 衍生的主动脉瓣钙化密度（AVC）评估解剖学 AS 严重程度。回顾性分析对全因死亡率的影响。
多变量线性回归显示 T-LVAo 与 AVC 相关性最强。根据单变量和多变量分析，T-LVAo 无预后意义。相比之下，使用个体 C 统计量得出的截止值（C），ET 或 AT≥C 的患者死亡率低于 ET 或 AT<C 的患者（1 年死亡率：ET≥与< C：15.01%与 33.1%，AT≥与< C：16.3%与 26.5%，p<0.001）。此外，多变量分析确定 ET≥C（HR 0.61 [95%CI 0.43-0.87；p<0.007]）与 TAVI 后有益结果相关，独立于临床危险因素和超声心动图衍生参数。
在所研究的血流动力学参数中，T-LVAo 提供了最高的诊断价值，而 ET 是 TAVI 后 AS 患者除临床危险因素和超声心动图参数外的预后预测因子。这些参数在 TAVI 患者的诊断评估和风险评估中可能具有重要用途。T-LVAo（黄色）：定义为左心室与主动脉收缩压峰值之间的时间。ET（绿色）：定义为从开始到流量结束的射血时间。AT（橙色）：定义为从开始到峰值流量的加速时间。AOP：主动脉压力，AVC：主动脉瓣钙化，CI：置信区间，HGAS：高梯度主动脉瓣狭窄，LGAS：低梯度主动脉瓣狭窄，LVP：左心室压力，SD：标准差。
