Importance of Flow in Risk Stratification of Aortic Stenosis

Guzzetti, Ezéquiel; Clavel, Marie‐Annick

doi:10.1016/j.cjca.2019.10.020

Cited by 4 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering our findings together with previous data [ 6 ] and expert opinion [ 14 ], we would argue that a SVI threshold of 30 ml/m 2 may be more prognostically appropriate in those with severe low-gradient AS with preserved EF, especially in female patients and/or those with BMI > 30 kg/m 2 . SVI levels between 30 and 35 ml/m 2 are more likely to correspond with ‘normal’ physiology in the presence of relatively small LV size and/or exaggerated BSA in these patient populations.…”

Section: Discussionsupporting

confidence: 71%

“…SVI is a measurement of left ventricular forward output; SVI < 35 ml/m 2 is accepted [ 2 ] to represent a state of reduced LV output, with SVI 25–30 ml/m 2 and SVI < 25 ml/m 2 representing moderately and severely reduced output, respectively [ 14 ]. In previous smaller studies, SVI ≤ 35 ml/m 2 has generally been associated with worse outcomes in adults with severe AS, either in those undergoing AVR or conservative management [ 7 , 17 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…In each severe low-gradient AS group, subjects were divided into four subgroups according to previously defined SVI thresholds [ 14 ]: SVI > 35 ml/m 2 (normal flow), SVI 30–35 ml/m 2 (mild low-flow), SVI 25–30 ml/m 2 (moderate low-flow) and SVI < 25 ml/m 2 (severe low-flow). Additionally, for a supplemental analysis (see Statistical Analysis section below), the “normal flow” subgroup was further divided into low-normal flow (SVI 35–40 ml/m 2 ) and high-normal flow (SVI > 40 ml/m 2 ).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The prognostic significance of stroke volume index in low gradient severe aortic stenosis: from the national echo database of Australia

Snir

Strange

et al. 2023

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Approximately 50% of patients with severe aortic stenosis (AS) in clinical practice present with ‘low-gradient’ haemodynamics. Stroke Volume Index (SVI) is a measure of left ventricular output, with ‘normal-flow’ considered as > 35 ml/m2. The association between SVI and prognosis in severe low-gradient AS (LGAS) in currently not well-understood. We analysed the National Echo Database of Australia (NEDA) and identified 109,990 patients with sufficiently comprehensive echocardiographic data, linked to survival information. We identified 1,699 with severe LGAS and preserved ejection fraction (EF) (≥ 50%) and 774 with severe LGAS and reduced EF. One- and three-year survival in each subgroup were assessed (follow-up of 74 ± 43 months), according to SVI thresholds. In patients with preserved EF the mortality “threshold” was at SVI < 30 ml/m2; 1- and 3-year survival was worse for those with SVI < 30 ml/m2 relative to those with SVI > 35 ml/m2 (HR 1.80, 95% CI 1.32–2.47 and HR 1.38, 95% CI 1.12–1.70), while survival was similar between those with SVI 30–35 ml/m2 and SVI > 35 ml/m2. In patients with reduced EF the mortality “threshold” was 35 ml/m2; 1- and 3-year survival was worse for both those with SVI < 30 ml/m2 and 30–35 ml/m2 relative to those with SVI > 35 ml/m2 (HR 1.98, 95% CI 1.27–3.09 and HR 1.41, 95% CI 1.05–1.93 for SVI < 30 ml/m2 and HR 2.02, 95% CI 1.23–3.31 and HR 1.56, 95% CI 1.10–2.21 for SVI 30–35 ml/m2). The SVI prognostic threshold for medium-term mortality in severe LGAS patients is different for those with preserved LVEF (< 30 ml/m2) compared to those with reduced LVEF (< 35 ml/m2).

show abstract

Section: Discussionsupporting

confidence: 71%