Cargando…

Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis

BACKGROUND: Time to peak velocity (TPV) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (AS). The aim of this study was to investigate the usefulness of TPV to evaluate AS severity. METHODS...

Descripción completa

Detalles Bibliográficos
Autores principales: Kamimura, Daisuke, Hans, Sartaj, Suzuki, Takeki, Fox, Ervin R., Hall, Michael E., Musani, Solomon K., McMullan, Michael R., Little, William C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121493/
https://www.ncbi.nlm.nih.gov/pubmed/27792660
http://dx.doi.org/10.1161/JAHA.116.003907
_version_ 1782469417717727232
author Kamimura, Daisuke
Hans, Sartaj
Suzuki, Takeki
Fox, Ervin R.
Hall, Michael E.
Musani, Solomon K.
McMullan, Michael R.
Little, William C.
author_facet Kamimura, Daisuke
Hans, Sartaj
Suzuki, Takeki
Fox, Ervin R.
Hall, Michael E.
Musani, Solomon K.
McMullan, Michael R.
Little, William C.
author_sort Kamimura, Daisuke
collection PubMed
description BACKGROUND: Time to peak velocity (TPV) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (AS). The aim of this study was to investigate the usefulness of TPV to evaluate AS severity. METHODS AND RESULTS: This study included 700 AS patients, whose aortic valve area (AVA) was <1.5 cm(2), and 200 control patients. The TPV was defined as the time from aortic valve opening to when the flow velocity across the aortic valve reaches its peak. AS severity was classified as follows: High gradient severe AS, mean pressure gradient ≥40 mm Hg and AVA index (AVAI) <0.6 cm(2)/m(2); Low gradient severe AS, mean pressure gradient <40 mm Hg, AVAI <0.6 cm(2)/m(2), and dimensionless index <0.25; moderate AS, mean pressure gradient <40 mm Hg, AVAI ≥0.6 cm(2)/m(2). The area under the receiver operating characteristic curve of TPV to predict high gradient severe AS was 0.94 (95% CI: 0.92–0.97, P<0.001). TPV was significantly delayed in low gradient severe AS compared with moderate AS both in patients with preserved (102±13 ms versus 83±13 ms, P<0.001) and with reduced ejection fraction (110±18 ms versus 88±13 ms, P<0.001). Delayed TPV was associated with increased all‐cause mortality or need for aortic valve replacement after adjustment for confounders (hazard ratio for first quartile, reference is fourth quartile: 7.31, 95% CI 4.26–12.53, P<0.001). CONCLUSIONS: TPV is useful to evaluate AS severity and predict poor prognosis of AS patients.
format Online
Article
Text
id pubmed-5121493
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-51214932016-12-06 Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis Kamimura, Daisuke Hans, Sartaj Suzuki, Takeki Fox, Ervin R. Hall, Michael E. Musani, Solomon K. McMullan, Michael R. Little, William C. J Am Heart Assoc Original Research BACKGROUND: Time to peak velocity (TPV) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (AS). The aim of this study was to investigate the usefulness of TPV to evaluate AS severity. METHODS AND RESULTS: This study included 700 AS patients, whose aortic valve area (AVA) was <1.5 cm(2), and 200 control patients. The TPV was defined as the time from aortic valve opening to when the flow velocity across the aortic valve reaches its peak. AS severity was classified as follows: High gradient severe AS, mean pressure gradient ≥40 mm Hg and AVA index (AVAI) <0.6 cm(2)/m(2); Low gradient severe AS, mean pressure gradient <40 mm Hg, AVAI <0.6 cm(2)/m(2), and dimensionless index <0.25; moderate AS, mean pressure gradient <40 mm Hg, AVAI ≥0.6 cm(2)/m(2). The area under the receiver operating characteristic curve of TPV to predict high gradient severe AS was 0.94 (95% CI: 0.92–0.97, P<0.001). TPV was significantly delayed in low gradient severe AS compared with moderate AS both in patients with preserved (102±13 ms versus 83±13 ms, P<0.001) and with reduced ejection fraction (110±18 ms versus 88±13 ms, P<0.001). Delayed TPV was associated with increased all‐cause mortality or need for aortic valve replacement after adjustment for confounders (hazard ratio for first quartile, reference is fourth quartile: 7.31, 95% CI 4.26–12.53, P<0.001). CONCLUSIONS: TPV is useful to evaluate AS severity and predict poor prognosis of AS patients. John Wiley and Sons Inc. 2016-10-22 /pmc/articles/PMC5121493/ /pubmed/27792660 http://dx.doi.org/10.1161/JAHA.116.003907 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Kamimura, Daisuke
Hans, Sartaj
Suzuki, Takeki
Fox, Ervin R.
Hall, Michael E.
Musani, Solomon K.
McMullan, Michael R.
Little, William C.
Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title_full Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title_fullStr Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title_full_unstemmed Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title_short Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
title_sort delayed time to peak velocity is useful for detecting severe aortic stenosis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121493/
https://www.ncbi.nlm.nih.gov/pubmed/27792660
http://dx.doi.org/10.1161/JAHA.116.003907
work_keys_str_mv AT kamimuradaisuke delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT hanssartaj delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT suzukitakeki delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT foxervinr delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT hallmichaele delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT musanisolomonk delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT mcmullanmichaelr delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis
AT littlewilliamc delayedtimetopeakvelocityisusefulfordetectingsevereaorticstenosis