Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: A Systematic Review and Meta-Analysis Publisher Pubmed



Mombeini H ; Hatamnejad MR ; Chichagi F ; Arbabi M ; Jamshidi P ; Sotoudehnia S ; Sahafi Bandary M ; Piroozkhah M
Source: American Journal of Cardiology Published:2026

Abstract

Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least 3 months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200–210 mL/s) was 1.31 (95% CI: 1.03–1.60, I2: 66%, p < 0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I2: 0%, p < 0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies. Systematic Review Registration: PROSPERO (registration number: CRD42023404048). © 2025 Elsevier Inc.