TY - JOUR
T1 - Survival by stroke volume index in patients with low-gradient normal EF severe aortic stenosis
AU - Eleid, Mackram F.
AU - Sorajja, Paul
AU - Michelena, Hector I.
AU - Malouf, Joseph F.
AU - Scott, Christopher G.
AU - Pellikka, Patricia A.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Objective: Low-gradient (LG) severe aortic stenosis (AS) and preserved EF with reduced stroke volume are associated with an adverse prognosis, but the relationship of stroke volume index (SVI) with mortality among a range of values is unknown. We investigated the prognostic impact of SVI in this population.Methods We examined 405 consecutive patients with preserved EF (≥50%) and severe AS (valve area <1.0 cm2) with LG (<40 mm Hg) using echocardiography. Patients were stratified into quartiles based on SVI distribution (group 1: <38 mL/m2(n=90), group 2: 38-43 mL/m2 (n=105), group 3: 43-48 mL/m2 (n=104) and group 4: >48 mL/m2 (n=106)).Results: Groups 1 and 2 had poorer survival with medical management compared with 3 and 4 (3-year estimate 46% and 67% vs. 78% and 73%, respectively, p=0.002) although aortic valve replacement referral rate was similar (53%-62%, p=0.57). An inverse relationship was observed between SVI and mortality (HR 1.28 (1.11 to 1.46) per every 5 mL/m2 decrease in SVI). After multivariable analysis, SVI was the strongest predictor of mortality (HR 0.92 (0.89 to 0.95), p<0.0001). Using different SVI cutpoints, SVI >35 was associated with highest mortality (HR 2.36 (1.49 to 3.73), p<0.001), followed by SVI <38 (HR 2.09 (1.39 to 3.16), p<0.001) and by SVI <43 (HR 2.05 (1.38 to 3.05), p<0.001). Survival with SVI ≥43 was similar to age and sex-matched controls (3-year estimate 84%, p=0.24); survival for SVI <43 was significantly worse (3-year estimate 63%, p<0.001).Conclusions: Lower SVI is incrementally associated with mortality in LG severe AS with preserved EF. These findings have implications for classification of AS severity, identification of high-risk groups and subsequent management.
AB - Objective: Low-gradient (LG) severe aortic stenosis (AS) and preserved EF with reduced stroke volume are associated with an adverse prognosis, but the relationship of stroke volume index (SVI) with mortality among a range of values is unknown. We investigated the prognostic impact of SVI in this population.Methods We examined 405 consecutive patients with preserved EF (≥50%) and severe AS (valve area <1.0 cm2) with LG (<40 mm Hg) using echocardiography. Patients were stratified into quartiles based on SVI distribution (group 1: <38 mL/m2(n=90), group 2: 38-43 mL/m2 (n=105), group 3: 43-48 mL/m2 (n=104) and group 4: >48 mL/m2 (n=106)).Results: Groups 1 and 2 had poorer survival with medical management compared with 3 and 4 (3-year estimate 46% and 67% vs. 78% and 73%, respectively, p=0.002) although aortic valve replacement referral rate was similar (53%-62%, p=0.57). An inverse relationship was observed between SVI and mortality (HR 1.28 (1.11 to 1.46) per every 5 mL/m2 decrease in SVI). After multivariable analysis, SVI was the strongest predictor of mortality (HR 0.92 (0.89 to 0.95), p<0.0001). Using different SVI cutpoints, SVI >35 was associated with highest mortality (HR 2.36 (1.49 to 3.73), p<0.001), followed by SVI <38 (HR 2.09 (1.39 to 3.16), p<0.001) and by SVI <43 (HR 2.05 (1.38 to 3.05), p<0.001). Survival with SVI ≥43 was similar to age and sex-matched controls (3-year estimate 84%, p=0.24); survival for SVI <43 was significantly worse (3-year estimate 63%, p<0.001).Conclusions: Lower SVI is incrementally associated with mortality in LG severe AS with preserved EF. These findings have implications for classification of AS severity, identification of high-risk groups and subsequent management.
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U2 - 10.1136/heartjnl-2014-306151
DO - 10.1136/heartjnl-2014-306151
M3 - Article
C2 - 25217490
AN - SCOPUS:84919776385
SN - 1355-6037
VL - 101
SP - 23
EP - 29
JO - Heart
JF - Heart
IS - 1
ER -