Low-flow Severe aortic stenosis (AS) with the normal flow was associated with a higher mortality rate. Low-flow AS was defined as a stroke volume index (SVi) of less than 35 mL/m2 as determined by echocardiography. The gold standard for measuring left ventricular volumes and function is cardiovascular magnetic resonance (CMR), which could be used to calculate SVi. The goal of this study was to see if there was a link between left ventricular SVi and myocardial remodeling and survival after valve replacement in individuals with severe AS. Patients with severe AS who were scheduled for surgical or transcatheter aortic valve replacement (SAVR or TAVR) were included in the study. Low-flow, low-gradient AS; low-flow, high-gradient AS; normal-flow, low-gradient AS; and normal-flow, high-gradient AS were the four AS endotypes identified using echocardiography-derived aortic valve mean and CMR-derived SVi.The patients were followed for an average of 3.6 years. About 425 (63.1%) of the 674 patients were male, with a median (IQR) age of 75 (66-80). The aortic valve area index was 0.4 (0.3-0.4) cm2/m2 with IQR. Patients with low-flow AS endotypes exhibited poorer left ventricular ejection fraction, mass, and wall thickness, as well as higher all-cause and CV mortality than patients with normal-flow AS (all-cause mortality: hazard ratio [HR], 2.08; 95% CI, 1.37-3.14; P<.001; CV mortality: HR, 3.06; 95% CI, 1.79-5.25; P<.001). Lower SVi (HR, 1.64; 95% CI, 1.08-2.50; P=.04), age (HR, 2.54; 95% CI, 1.29-5.01; P=.001), and more late gadolinium enhancement (HR, 2.93; 95% CI, 1.68-5.09; P<.001) were all independently linked with CV mortality.
Source:jamanetwork.com/journals/jamacardiology/article-abstract/2790671
