Assessment of Aortic Arch Wall Motion Velocities in Severe Aortic Stenosis: A Transthoracic and Transesophageal Echocardiography Study

Abstract

Background

This study aimed to evaluate the diagnostic utility of a novel parameter—arcus aorta wall motion velocities (AA-WMV)—measured by pulse-wave tissue Doppler imaging (PW-TDI) during TEE, and to compare its performance with established stiffness indices.

Methods

In this prospective study, 196 patients with aortic stenosis (AS) and 128 controls without AS underwent TEE. AA-WMV parameters—systolic (Vs) and diastolic (Vd) velocities—were assessed using PW-TDI of the aortic arch. Conventional aortic stiffness markers, including valvuloarterial impedance (ZVA), total arterial compliance index (TAC-index), pulse wave velocity, and aortic intima-media thickness (Ao-IMT), were also measured.

Results

Vs (3.35 ± 0.73 vs. 4.08 ± 0.69 cm/s, p < 0.001) and Vd (2.65 ± 0.98 vs. 3.67 ± 0.65 cm/s, p < 0.001) were significantly lower in AS patients compared to controls. In multivariable logistic regression, Vs (aOR:0.27, 95% CI: 0.14–0.55, p < 0.001) and Vd (aOR:0.14, 95% CI: 0.07–0.31, p < 0.001) remained independent predictors of AS, alongside stroke volume-index and interventricular septal thickness. ROC analysis demonstrated the highest discriminative capacity for Vd (AUC = 0.837), followed by Vs (AUC = 0.783). The combined Vs+Vd model yielded optimal performance (C-index = 0.87), improved calibration (Brier score = 0.145), and superior model fit (pseudo-R² = 0.337, AIC = 274.3). Compared to the Vs model alone, the combined model significantly improved reclassification metrics, including net reclassification improvement (NRI = 105.6%, p < 0.001), integrated discrimination improvement (IDI = 18.7%, p < 0.001), and median improvement index (4.9%, p < 0.001). The Vs+Vd model also provided greater net clinical benefit.

Conclusions

AA-WMV parameters—particularly Vd—offer a simple, reproducible, and effective approach for evaluating aortic stiffness in AS. While Vs and Vd individually hold diagnostic value, their combined use enhances discriminatory and prognostic accuracy, surpassing traditional aortic stiffness indices in patients undergoing TEE.