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Original research article
Impact of stroke volume on cardiovascular risk during progression of aortic valve stenosis
  1. Mai Tone Lønnebakken1,
  2. Giovanni De Simone2,
  3. Sahrai Saeed3,
  4. Kurt Boman4,
  5. Anne B Rossebø5,
  6. Edda Bahlmann6,
  7. Christa Gohlke-Bärwolf7,
  8. Eva Gerdts1
  1. 1 Department of Clinical Science, University of Bergen, Bergen, Norway
  2. 2 Department of Translational Medical Science, Hypertension Research Center, Federico II University Hospital, Naples, Italy
  3. 3 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  4. 4 Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden
  5. 5 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
  6. 6 Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
  7. 7 Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
  1. Correspondence to Dr Mai Tone Lønnebakken, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway; Mai.Lonnebakken{at}


Objective In severe aortic valve stenosis (AS), low left ventricular (LV) stroke volume has been associated with increased cardiovascular (CV) mortality, but this association has not been explored during progression of AS in a large prospective study.

Methods In 1671 patients from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, the association of stroke volume indexed for body surface area (SVI) with major CV events during a median of 4.3-year follow-up was assessed in Cox and time-varying Cox regression analyses. Low SVI was defined as <35 mL/m2.

Results Peak aortic jet velocity in the total study population was 3.1 ±0.7 m/s. Low SVI was found in 23% at baseline and associated with higher age, body mass index (BMI), heart rate and global LV load, and with lower mean aortic gradient, aortic valve area index, energy loss index, LV mass and ejection fraction and more often inconsistent AS grading (all p<0.05). A 5 mL/m2 lower SVI at baseline was associated with higher HRs of major CV events (n=544) (HR 1.09, 95% CI 1.05 to 1.13, p<0.001) and higher total mortality (n=147) (HR 1.08, 95% CI 1.01 to 1.16, p=0.038), independent of age, sex, atrial fibrillation, mean aortic gradient, LV ejection fraction, LV mass, BMI and study treatment. Adjusting for the same covariates, low SVI at baseline and in-study low SVI were also associated with increased rate of major CV events.

Conclusion In patients with AS in the SEAS study, lower baseline SVI was associated with higher HR of major CV events and total mortality independent of major confounders.

Trial registration number NCT00092677: Results

  • Stroke volume
  • Stroke index
  • Aortic valve stenosis
  • Prognosis

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  • Contributors MTL, GdS and EG were involved in the conception and design as well as analysis and interpretation of data. All coauthors have revised the manuscript critically and approved it for submission to Heart.

  • Funding The SEAS Echocardiography Core Laboratory was supported by MSP Singapore Company, LLC, a partnership between Merck & Co, Inc, and Schering-Plough Corporation.

  • Competing interests EG received steering committee honorarium and funding for the echocardiography core laboratory from Merck Schering Plough during the study period 2002–8. KB received steering committee honorarium and speaker honoraria from Merck Schering Plough during the study period 2002–8. ABR received steering committee honorarium from Merck Schering Plough during the study period 2002–8. The other authors have no disclosures related to this study.

  • Patient consent Written informed consent was obtained from all participants.

  • Ethics approval Regional ethics committees in all participating countries.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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