PMID- 33250431
OWN - NLM
STAT- MEDLINE
DCOM- 20210519
LR  - 20210519
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 35
IP  - 3
DP  - 2021 Mar
TI  - Aortic Acceleration Time and the Intraoperative Assessment of Aortic Stenosis.
PG  - 820-825
LID - S1053-0770(20)31162-9 [pii]
LID - 10.1053/j.jvca.2020.10.048 [doi]
AB  - OBJECTIVES: Aortic acceleration time (AAT) and the ratio of AAT to ejection time 
      (AAT/ET) are relatively new echocardiographic measures of the severity of aortic 
      stenosis (AS). This study investigated the utility of transesophageal 
      echocardiography (TEE) measurements of AAT and AAT/ET to predict the severity of 
      AS under intraoperative conditions. DESIGN: Retrospective diagnostic accuracy 
      study. SETTING: St. Vincent's Hospital, Melbourne, Australia, from July 2007 to 
      February 2017. PARTICIPANTS: The study comprised 199 patients who underwent 
      aortic valve replacement (AVR) and whose aortic valves were evaluated with 
      spectral Doppler analysis in both preoperative transthoracic echocardiography 
      (TTE) and intraoperative TEE studies fewer than three months apart. Exclusion 
      criteria included AVR for only aortic regurgitation, AVR of prosthetic aortic 
      valves, and known left ventricular outflow tract obstruction. MEASUREMENTS AND 
      MAIN RESULTS: Standard echocardiography assessment of AS and the AAT and AAT/ET 
      measurements was performed using preoperative TTE and intraoperative TEE. The 
      intraoperative AAT and AAT/ET were increased significantly in patients with both 
      high- and low-gradient severe AS compared with patients without severe AS (p < 
      0.01). Comparing preoperative TTE and intraoperative TEE measurements showed that 
      the AAT was significantly prolonged during general anesthesia (mean difference 
      9.67 msec [95% confidence interval -13.54 to -5.81]), whereas the AAT/ET was 
      preserved (mean difference -0.0018 [95% confidence interval -0.013 to 0.0091]). 
      An intraoperative TEE cutoff of 109 msec for AAT and 0.35 for AAT/ET had a 74% 
      and 67% sensitivity and 72% and 78% specificity, respectively, to differentiate 
      severe from non-severe AS. CONCLUSIONS: The AAT and AAT/ET may be useful adjuncts 
      for the intraoperative measurement of AS. The agreement between intraoperative 
      TEE and preoperative TTE was better with AAT/ET compared with AAT alone.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Burns, David
AU  - Burns D
AD  - Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, 
      Melbourne, Australia. Electronic address: David.Burns@svha.org.au.
FAU - Kluger, Roman
AU  - Kluger R
AD  - Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, 
      Melbourne, Australia.
FAU - Uda, Yoshiaki
AU  - Uda Y
AD  - Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, 
      Melbourne, Australia.
FAU - Cowie, Brian
AU  - Cowie B
AD  - Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, 
      Melbourne, Australia.
LA  - eng
PT  - Journal Article
DEP - 20201030
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
SB  - IM
MH  - Acceleration
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery
MH  - Australia
MH  - Echocardiography, Transesophageal
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Retrospective Studies
OTO - NOTNLM
OT  - anesthesia
OT  - aortic acceleration time
OT  - aortic valve stenosis
OT  - echocardiography, transesophageal
OT  - ejection time
EDAT- 2020/12/01 06:00
MHDA- 2021/05/20 06:00
CRDT- 2020/11/30 05:34
PHST- 2020/06/07 00:00 [received]
PHST- 2020/10/22 00:00 [revised]
PHST- 2020/10/23 00:00 [accepted]
PHST- 2020/12/01 06:00 [pubmed]
PHST- 2021/05/20 06:00 [medline]
PHST- 2020/11/30 05:34 [entrez]
AID - S1053-0770(20)31162-9 [pii]
AID - 10.1053/j.jvca.2020.10.048 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2021 Mar;35(3):820-825. doi: 
      10.1053/j.jvca.2020.10.048. Epub 2020 Oct 30.