We sought to evaluate and compare both the prognostic value of acceleration time (AT) and the ratio of AT to ejection time (AT/ET) in aortic stenosis (AS).

Ejection dynamics parameters are useful in assessing prosthetic valve obstruction but very limited data are available in the setting of native AS.

AT and AT/ET were measured in a prospective cohort of patients with aortic stenosis (AVA < 1.3 cm²). The relationships between AT/ET, AT, overall and cardiovascular mortality during follow-up were studied.

Four hundred and fifty-six patients with AS (mean AVA 0.85 ± 0.24 cm²) were included. After adjustment on variables of prognostic importance and on AVR as a time-dependent covariate, patients in the highest tertile of both AT/ET (> 0.36) and AT (> 112 ms) were at high risk of overall mortality (HR 2.57 [1.68–3.94] and HR 2.06 [1.33–3.18] respectively) and of cardiovascular mortality (HR 3.33[1.78–6.21] and HR 2.36[1.30–4.30] respectively), compared to patients in the lowest tertiles of AT/ET and AT, while the survival was similar for the other tertiles (all P values = NS). Compared to patients with an AT/ET≤ 0.36, an increased risk of overall and cardiovascular mortality was observed in patients with AT/ET > 0.36 (adjusted HR 2.55 [1.79–3.62] and adjusted HR 3.40 [2.05–5.64] respectively). Compared to patients with an AT≤ 112 ms, an increased risk of overall and cardiovascular mortality was observed in patients with AT > 112 ms (adjusted HR 1.75 [1.21–2.53] and adjusted HR 2.23[1.34–3.71] respectively). However, AT/ET showed better predictive performance than AT in terms of both overall and cardiovascular mortality with improved global model fit, reclassification, and better discrimination.

Ejection dynamics parameters in AS, particularly AT/ET, are strongly associated with an excess risk of death during follow-up. AT/ET should be considered in the multi-parametric echocardiographic prognostic assessment of AS in clinical practice.