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

Abstract

Low-flow (LF) aortic stenosis (AS) with a normal ejection fraction reportedly has a worse prognosis than normal-flow (NF) AS. We assessed whether the stroke volume affects early- and long-term survival of patients with AS undergoing aortic valve replacement. From 2007 to 2016, 179 patients with AS and a normal ejection fraction (≥ 50%) and without other valve diseases were divided into two groups according to the stroke volume index (SVI): NF group (SVI ≥ 35ml/m2, n = 167) and LF group (SVI < 35ml/m2, n = 12). Early- and long-term survival was compared between the two groups. Preoperative echocardiography showed that the end-diastolic diameter and aortic valve area were smaller in the LF than NF group (43 ± 1.9 vs. 48 ± 0.4mm, p < 0.005 and 0.33 ± 0.14 vs. 0.49 ± 0.14cm2/m2, p < 0.0005, respectively). Hospital mortality was significantly higher (16.7% vs. 1.8%, p < 0.05) and 5-year overall survival was lower (58 ± 17 vs. 84 ± 4.2months, p < 0.005) in the LF than NF group. Patients with LF AS had worse operative and long-term outcomes than those with NF, even though they had preserved LV function.