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Optimal management of asymptomatic patients with aortic stenosis (AS) remains one of the challenges of modern cardiology. Attention has focused on improving risk stratification in these patients, with the aim of identifying important biomarkers of disease progression and outcome, so that early intervention can be targeted to those who would potentially benefit the most, without additional risk.
Low flow, or a reduced stroke volume index (SVI, stroke volume/body surface area), has been identified as one of the markers of poor prognosis in patients with both symptomatic1 2 and asymptomatic severe AS.3 A study published in this issue of Heart aimed to investigate the effect of SVI on outcome in asymptomatic patients with mild to moderate AS from the SEAS study cohort. The SEAS study was a multicentre, prospective, double-blind placebo-controlled study in asymptomatic patients with peak transvalvular jet velocity of 2.5–4.0 m/s, randomised to treatment with simvastatin and ezetimibe or placebo.4 Lonnebakken et al 5 have looked at the association of SVI with major cardiovascular events and all-cause mortality during a median follow-up period of 4.3 years in 1671 of the total 1873 of the SEAS patients, …
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