Relation of Transthoracic Echocardiographic Aortic Regurgitation to Pressure Half-time and All-Cause Mortality

• Published in: The American journal of cardiology 2020-11, Vol.135, p.113-119
• Main Authors: Strom, Jordan B., Gelfand, Eli V., Markson, Lawrence J., Tsao, Connie A., Manning, Warren J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic valve; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Blood pressure; Cause of Death; Deceleration; Diastole; Echocardiography; Endocarditis; Female; Heart valves; Humans; Male; Mathematical analysis; Middle Aged; Mitral valve; Mortality; Pulmonary artery; Regurgitation; Retrospective Studies; Software; Systolic pressure; Ultrasonic imaging; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.08.043

To evaluate the relation of aortic regurgitation (AR) pressure half-time (PHT) on transthoracic echocardiography (TTE) and all-cause mortality, we screened 118,647 baseline TTE reports from 2000 to 2017, to identify patients with any AR and PHT data. Patients with infective endocarditis or previous aortic valve replacement were excluded. The relation of baseline PHT on time to all-cause mortality was evaluated using Cox regression. A total of 2,653 patients were included (73.1 ± 14.3 years; 53.8% female; PHT, 530 ± 162 ms). Patients with shorter PHTs more frequently had 3-4+ AR (PHT ≤ 200 ms vs > 500 ms, 17.9% vs 0.6%, p < 0.0001). Diastolic parameters (E/e’, E/A ratio, mitral valve deceleration time, and pulmonary artery systolic pressure) all significantly correlated with PHT (all p < 0.05). Over a median (IQR) follow-up of 8 (4 to 11 years), there were 799 (30.1%) deaths at a median (IQR) of 1.9 (0.4 to 4.3) years. On a univariate basis, a PHT ≤ 320 ms or > 750 ms was significantly related to increased mortality, even amongst those with nonsevere AR. After multivariable adjustment (in particular for E/e’), PHT was no longer significantly related to death. In conclusion, in this large, single center, retrospective study, AR PHT was not independently related to mortality. While a PHT ≤ 320 ms was associated with increased mortality in patients without severe AR, this relation was no longer significant after adjusting for diastolic functional variables. Thus, a PHT ≤ 320 ms in patients without significant AR may indicate prognostically-relevant diastolic dysfunction. •PHT is a common TTE technique to evaluate AR severity, though is impacted by left ventricular compliance, aortic compliance, and systolic vascular resistance and need for parallel insonation.•Although an AR PHT ≤ 320 ms was associated with increased mortality risk, regardless of AR severity, this was no longer significant after adjustment for diastolic functional variables.•If independently confirmed, an AR PHT ≤ 320 ms in those without significant AR may indicate prognostically significant diastolic dysfunction.