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. 2025 Aug;38(8):643-654.
doi: 10.1016/j.echo.2025.02.017. Epub 2025 Mar 8.

Transaortic Flow Rate and Risk Stratification in Moderate Aortic Stenosis

Paolo Springhetti  1 , Michele Tomaselli  2 , Leonardo Portolan  3 , Marco Penso  2 , Jessica Pizzini  3 , Denis Leonardi  3 , Alexandra Clement  4 , Luca Ciceri  3 , Noela Radu  2 , Giorgia Benzoni  4 , Roberto Scarsini  3 , Flavio Ribichini  3 , Denisa Muraru  5 , Giovanni Benfari  6 , Luigi P Badano  5
Affiliations
Free article

Transaortic Flow Rate and Risk Stratification in Moderate Aortic Stenosis

Paolo Springhetti et al. J Am Soc Echocardiogr. 2025 Aug.
Free article

Abstract

Background: While left ventricular stroke volume (SV) is commonly used to define flow status in patients with aortic valve stenosis (AS), flow rate (FR) serves as a more precise descriptor of blood flow. However, evidence regarding the prognostic significance and determinates of transaortic FR, specifically in patients with a moderate AS, is limited.

Objectives: We aimed to evaluate the association of transaortic FR with outcomes in patients with moderate AS.

Methods: We included 292 outpatients (mean age, 80 ± 9 years; 45% women) with moderate AS (aortic valve area, 1-1.5 cm2) and complete clinical evaluation. Transaortic FR was calculated using the derivation-method (FRder) and validated in 90 random patients in whom transaortic FR was also directly calculated as SV/ejection time (FRdir). The primary study end point was a composite of all-cause mortality and hospitalization for heart failure (HHF).

Results: After median follow-up of 19.3 (interquartile range, 12.3-26.0) months, 73 patients reached the primary end point (22 HHF and 51 deaths). Patients who met the primary end point had a lower transaortic FRder value compared to those not experiencing events (201 ± 47 mL/sec vs 225 ± 48 mL/sec). The transaortic FRder presented excellent correlation with FRdir (R2 = 0.93, P < .0001). The transaortic FRder threshold for excess risk of adverse outcome was approximately 218 mL/sec. Below this value, the risk increased steeply, showing no plateau effect. Several factors were independently associated with transaortic FRder < 218 mL/sec, including female sex, renal insufficiency, previous myocardial infarction, SV index, and at least moderate tricuspid regurgitation (all P < .02). After comprehensive adjustment, transaortic FRder < 218 mL/sec turned out to be independently associated with events (adjusted hazard ratio, 2.17 [95% CI, 1.14-4.12], P = .018).

Conclusions: Transaortic FRder < 218 mL/sec is independently associated with adverse outcomes in moderate AS. Further research is needed to determine whether patients with moderate AS and impaired transaortic FR would benefit from more intensive monitoring or earlier aortic valve replacement.

Keywords: Moderate aortic stenosis; Outcomes; Risk stratification; Transaortic flow rate.

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Conflict of interest statement

Conflict of interest Dr. Muraru and Dr. Badano are members of the speaker bureaus of GE healthcare and Philips Medical systems, and received research grants from GE Healthcare, Philips Medical Systems, TomTec Imaging Systems, and ESaOTE SpA. The remaining authors have nothing to disclose.