Impact of stroke volume on severe aortic stenosis in patients with normal left ventricular function

Fukui, Shinya; Kakizawa, Yumi; Handa, Kazuma; Sakamoto, Tomohiko; Shirakawa, Yukitoshi

doi:10.1007/s11748-019-01173-9

Cited by 3 publications

(7 citation statements)

References 32 publications

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“…In their study, the patients only had normal LV function, and most had undergone implantation of a 19-mm valve. Hospital mortality was significantly higher and 5-year overall survival was lower in the LF group than in the NF group [3], similar to other reports. Kataoka et al [4] studied 723 patients with a mean age of 85 years who had undergone TAVI.…”

Section: Discussionsupporting

confidence: 91%

“…Many reports have also shown that a low SVI is associated with the prognosis of severe AS after surgical treatment (AVR or TAVI). The SVI is a recognized feature that aids workup and management of AS [1][2][3][4][5][6]. In the present study, almost a quarter of the patients with severe AS had a low SVI.…”

Section: Discussionmentioning

confidence: 52%

“…These authors reported that hospital mortality was higher and the 5-year survival rate was lower in the LF group than in the NF group. Fukui et al [ 3 ] studied 179 patients with AVR with a mean age in the seventh decade of life. In their study, the patients only had normal LV function, and most had undergone implantation of a 19-mm valve.…”

Section: Discussionmentioning

confidence: 99%

“…Aortic stenosis (AS) is the most common valve disorder and the most frequent indication for surgical treatment, aortic valve replacement (AVR), or transcatheter aortic valve implantation (TAVI) in advanced age. Previous reports have shown that low-flow status of the left ventricle (LV) is an independent predictor of cardiovascular mortality and longterm results after AVR or TAVI [1][2][3][4][5][6]. However, evaluating the low-flow status in severe AS patients is difficult because the reasons for low flow are multifactorial, including impaired myocardial contractility, restrictive physiological features, and afterload mismatch with high valvuloarterial impedance [7].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, the stroke volume index (SVI), which is measured in LV outflow in pulsed-wave Doppler recordings, has been considered the most comprehensive indicator of LV function. Previous reports [1][2][3][4][5][6] have shown that a low SVI is an independent predictor of operative or long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

et al. 2021

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Aortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

et al. 2021

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Echocardiography and EuroSCORE II for the stratification of low-gradient severe aortic stenosis and preserved left ventricular ejection fraction

Fan

Shen

Stacey

et al. 2021

Int J Cardiovasc Imaging

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The purpose of this study was to explore the utility of echocardiography and the EuroSCORE II in stratifying patients with low-gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF ≥ 50%) with or without aortic valve intervention (AVI). The study included 323 patients with LG SAS (aortic valve area ≤ 1.0 cm2 and mean pressure gradient < 40 mmHg). Patients were divided into two groups: a high-risk group (EuroSCORE II ≥ 4%, n = 115) and a low-risk group (EuroSCORE II < 4%, n = 208). Echocardiographic and clinical characteristics were analyzed. All-cause mortality was used as a clinical outcome during mean follow-up of 2 ± 1.3 years. Two-year cumulative survival was significantly lower in the high-risk group than the low-risk patients (62.3% vs. 81.7%, p = 0.001). AVI tended to reduce mortality in the high-risk patients (70% vs. 59%; p = 0.065). It did not significantly reduce mortality in the low-risk patients (82.8% with AVI vs. 81.2%, p = 0.68). Multivariable analysis identified heart failure, renal dysfunction and stroke volume index (SVi) as independent predictors for mortality. The study suggested that individualization of AVI based on risk stratification could be considered in a patient with LG SAS and preserved LVEF.

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A novel cardiovascular magnetic resonance risk score for predicting mortality following surgical aortic valve replacement

Vassiliou

Pavlou

Malley

et al. 2021

Sci Rep

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The increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm2, LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care.Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936.

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Impact of stroke volume on severe aortic stenosis in patients with normal left ventricular function

Cited by 3 publications

References 32 publications

Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

Echocardiography and EuroSCORE II for the stratification of low-gradient severe aortic stenosis and preserved left ventricular ejection fraction

A novel cardiovascular magnetic resonance risk score for predicting mortality following surgical aortic valve replacement

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