The ratio of acceleration time to ejection time (AT/ET) is a simple and reproducible echocardiographic parameter that integrates AS severity and its consequences on the LV. The prognostic impact of AT/ET on outcome in patients with SAS and no or mild symptoms has not been investigated. This study sought to determine the prognostic impact of AT/ET on mortality in patients with severe aortic stenosis (SAS), preserved left ventricular ejection fraction (LVEF) and no or only mild symptoms.

Three hundred and fifty-three patients [median age 79 (71–85), 46% women] with high gradient [mean pressure gradient≥40mmHg and/or aortic peak jet velocity (Vmax)≥4m/s] SAS, LVEF≥50% and no or only mild AS symptoms were studied. Patients were retrospectively stratified by AT/ET≤ or>0.35. Survival analyses were carried out to study the impact of AT/ET on all-cause mortality.

During a median follow-up of 39 (23–62) months, 70 patients died. AT/ET>0.35 was associated with a considerable increased mortality risk after adjustment for established prognostic factors in SAS when the entire follow up (medical and/or surgical management) was considered [adjusted HR 2.54 (95%CI,1 .47–4.37); P<0.001] but also under medical management [adjusted HR 3.29 (95%CI, 1.70–6.39); P<0.001]. In addition, AT/ET>0.35 improved the predictive performance of multivariable models including established risk factors in SAS as indicated by better global model fit, reclassification, and discrimination. After propensity score matching (n=236), increased risk of mortality persisted for patients with AT/ET>0.35 compared with those with AT/ET≤0.35 [adjusted HR 2.67 (95% CI, 1.45–4.92); P=0.002] (Fig. 1).

AT/ET>0.35 is a strong predictor of outcome in patients with SAS and no or only mild symptoms and identifies a subgroup of patients at higher risk of death who may derive benefit from earlier aortic valve replacement.