Identifying missing tools in aortic systolic upstroke parameter for valvular aortic stenosis diagnosis

Abstract Background Echocardiography is a widely accepted method for diagnosing severe aortic stenosis (AS), but it has certain limitations. Alternative methods, such as the direct catheter-based crossing of the valves, carry a risk of stroke. Delayed aortic upstroke parameters might predict the severity of aortic stenosis. Objective This study aimed to investigate the diagnostic utility of measuring catheter-based aortic acceleration time with ejection (AT/ET) for the diagnosis of severe aortic stenosis, including low-gradient (LG) AS. Methods We included 139 patients who underwent cardiac catheterization at our hospital, including patients with varying degrees of AS. Patients with LGAS were classified byan algorithm according to ESC guideline. All patients received echocardiographicassessments and direct hemodynamic measurements of AT/ET. The association between AT/ET and AS severity and other conventional utilities was analyzed using logistic regression and ROC analysis. Results Among the 139 patients, 73 had severe AS (52.5%), and 20 also had low gradient (27.3%). The mean AT/ET was 0.33 in the severe AS group and 0.28, 0.24 in moderate, and mild-no AS patients, respectively. AT/ET was significantly correlated with conventional echocardiographic and hemodynamic parameters. Furthermore, AT/ET is the strongest predictor of severe aortic stenosis using the multivariable test with relevant variables (OR; 2.01, 95% CI 1.17-3.45). Using a cut-off value of 0.30, catheter-based AT/ET had a sensitivity of 80% and specificity of 92% for diagnosing severe AS (AUC 0.94, 95% CI 0.90-0.97), withconsistent results from subgroup LGAS (AUC 0.94, 95% CI 0.93-0.99). Conclusion This study supports the use of catheter-based AT/ET of greater than 0.30 as a complementary diagnostic tool for severe aortic stenosis across the spectrum of low-gradient AS. Further studies are needed to validate these findings in larger, multicenter studies with more diverse patient populations.