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Original article
Survival by stroke volume index in patients with low-gradient normal EF severe aortic stenosis
  1. Mackram F Eleid1,
  2. Paul Sorajja1,
  3. Hector I Michelena1,
  4. Joseph F Malouf1,
  5. Christopher G Scott2,
  6. Patricia A Pellikka1
  1. 1Divisions of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  2. 2Divisions of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Mackram F Eleid, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905, USA; eleid.mackram{at}


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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