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Background <p>Determining the severity of aortic stenosis (AS) with low-flow (LF) status remains challenging because conventional echocardiographic indicators often yield discordant results. The velocity ratio (VR), in addition to the aortic valve calcium (AVC) score, has been proposed as a supplemental parameter that is less influenced by flow status. This study evaluates the relationship between the VR and the AVC burden, and determines whether the VR serves as a better predictor of the AVC burden than conventional echocardiographic parameters, particularly in patients with LF.</p> Methods <p>We retrospectively analyzed the data of 405 patients with at least mild AS who underwent multidetector computed tomography and Doppler echocardiography. Patients were categorized into four groups: LF, normal flow (NF)-low, NF-high and high flow (HF) status. We investigated the relationship between AVC and three echocardiographic indicators (VR, transvalvular mean pressure gradient [MPG], and aortic valve area indexed to body surface area [AVAi]) within each group. Multiple regression models were constructed to predict AVC, incorporating all possible combinations of echocardiographic indicators and relevant covariates. Model performance was assessed by comparing the ranking of the models that included a given echocardiographic indicator with those that excluded it.</p> Results <p>The study included 59 patients with LF, 161 with NF-low, 136 with NF-high, and 49 with HF. In all groups, VR, MPG, and AVAi were significantly associated with AVC in the simple linear regression analysis. Notably, in the LF group, the VR was included in all three of the top-ranking multiple regression models for AVC, and models containing the VR ranked significantly higher than those without it. By contrast, the inclusion of the MPG or AVAi did not significantly affect the model ranking in the LF group. No significant differences in model ranking were noted with versus without the VR in the HF group.</p> Conclusions <p>In patients with LF AS, the VR was a reliable marker for assessing the AVC burden, underscoring its value for clinical decision making in severe AS. Its superior predictive performance compared to conventional echocardiographic parameters highlights its potential to refine diagnostic accuracy in this population.</p>

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The velocity ratio as a predictor of valve calcium degeneration in aortic stenosis with low flow status

  • 期刊论文

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  • 发表日期：

    2025年11月3日

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  • Hiroki Okamoto,
  • Atsushi Hayashi,
  • Jun Matsubayashi,
  • Daiki Yoshida,
  • Misato Kodama,
  • Yosuke Higo,
  • Kohei Asada,
  • Yoshihisa Nakagawa

摘要

Background

Determining the severity of aortic stenosis (AS) with low-flow (LF) status remains challenging because conventional echocardiographic indicators often yield discordant results. The velocity ratio (VR), in addition to the aortic valve calcium (AVC) score, has been proposed as a supplemental parameter that is less influenced by flow status. This study evaluates the relationship between the VR and the AVC burden, and determines whether the VR serves as a better predictor of the AVC burden than conventional echocardiographic parameters, particularly in patients with LF.

Methods

We retrospectively analyzed the data of 405 patients with at least mild AS who underwent multidetector computed tomography and Doppler echocardiography. Patients were categorized into four groups: LF, normal flow (NF)-low, NF-high and high flow (HF) status. We investigated the relationship between AVC and three echocardiographic indicators (VR, transvalvular mean pressure gradient [MPG], and aortic valve area indexed to body surface area [AVAi]) within each group. Multiple regression models were constructed to predict AVC, incorporating all possible combinations of echocardiographic indicators and relevant covariates. Model performance was assessed by comparing the ranking of the models that included a given echocardiographic indicator with those that excluded it.

Results

The study included 59 patients with LF, 161 with NF-low, 136 with NF-high, and 49 with HF. In all groups, VR, MPG, and AVAi were significantly associated with AVC in the simple linear regression analysis. Notably, in the LF group, the VR was included in all three of the top-ranking multiple regression models for AVC, and models containing the VR ranked significantly higher than those without it. By contrast, the inclusion of the MPG or AVAi did not significantly affect the model ranking in the LF group. No significant differences in model ranking were noted with versus without the VR in the HF group.

Conclusions

In patients with LF AS, the VR was a reliable marker for assessing the AVC burden, underscoring its value for clinical decision making in severe AS. Its superior predictive performance compared to conventional echocardiographic parameters highlights its potential to refine diagnostic accuracy in this population.