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Survival by stroke volume index in low-gradient normal EF severe aortic stenosis: insights into myocardial systolic dysfunction
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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 …