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Survival by stroke volume index in low-gradient normal EF severe aortic stenosis: insights into myocardial systolic dysfunction
  1. Jonathan C L Rodrigues1,2,
  2. Amardeep Ghosh Dastidar1,
  3. Stephen Rohan3,
  4. David H MacIver4,5
  1. 1CMR Department, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol, UK
  2. 2School of Physiology and Pharmacology, The University of Bristol, Bristol, UK
  3. 3Medical School, The University of Bristol, Bristol, UK
  4. 4Department of Cardiology, Taunton and Somerset Hospital, Taunton, UK
  5. 5Department of Biological Physics, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Jonathan C L Rodrigues, CMR Unit, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK; jonathan.rodrigues{at}uhbristol.nhs.uk

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To the Editor,

We read with interest the recent article on survival by stroke volume index (SVI) in patients with low-gradient normal EF severe aortic stenosis, which demonstrated lower SVI is incrementally associated with mortality.1

The authors discuss a putative mechanism of low stroke volume (SV) secondary to concentric remodelling which results in reduced LV cavity size. This impedes LV diastolic filling culminating in diminished systolic function despite normal EF. The authors quote evidence of systolic impairment, for example reduced longitudinal strain, in similar cohorts with preserved EF.2 In the current study, the subgroup with lowest SVI, and therefore presumed most …

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