Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction

Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction

Abstract Aims In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:European heart journal 2018-06, Vol.39 (21), p.1992-1999
Hauptverfasser: Rusinaru, Dan, Bohbot, Yohann, Ringle, Anne, Maréchaux, Sylvestre, Diouf, Momar, Tribouilloy, Christophe
Format: Artikel
Sprache:eng
Schlagworte:
Life Sciences
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1999
container_issue 21
container_start_page 1992
container_title European heart journal
container_volume 39
creator Rusinaru, Dan
Bohbot, Yohann
Ringle, Anne
Maréchaux, Sylvestre
Diouf, Momar
Tribouilloy, Christophe
description Abstract Aims In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)
doi_str_mv 10.1093/eurheartj/ehy123
format Article
fullrecord <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03580336v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehy123</oup_id><sourcerecordid>2014951075</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-80e85dfb38213c15c5a6bed3a5c8d764e74fcf217faf6ff97fd5ae341500a70d3</originalsourceid><addsrcrecordid>eNqFkbFv1DAUhy1ERY_CzoQ8glBaO46dZKyqQiudxNJKbNY751nnw4mD7aS6kf-clJRbmfxkfd-3_Aj5wNklZ624winuEWI-XOH-yEvximy4LMuiVZV8TTaMt7JQqvlxTt6mdGCMNYqrN-S8bGVVt02zIb_v-xFMpsFSH55oyjH8RDoHP_VIw0D7EDN4l4_UDXSE7HDIiT65vKcJZ4xIYSGcWUwcQnKJwtDRMWLCOGNHPdpM50WKzkweIsUDmuyWso3w93hHziz4hO9f3gvy-PX24eau2H7_dn9zvS1MxXkuGoaN7OxONCUXhksjQe2wEyBN09Wqwrqyxpa8tmCVtW1tOwkoKi4Zg5p14oJ8Xrt78HqMrod41AGcvrve6uc_JmTDhFAzX9hPKzvG8GvClHXvkkHvYcAwJV0yXrWSs1ouKFtRE0NKEe2pzZl-HkmfRtLrSIvy8aU-7XrsTsK_VRbgywqEafx_7g-u6aNs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2014951075</pqid></control><display><type>article</type><title>Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Rusinaru, Dan ; Bohbot, Yohann ; Ringle, Anne ; Maréchaux, Sylvestre ; Diouf, Momar ; Tribouilloy, Christophe</creator><creatorcontrib>Rusinaru, Dan ; Bohbot, Yohann ; Ringle, Anne ; Maréchaux, Sylvestre ; Diouf, Momar ; Tribouilloy, Christophe</creatorcontrib><description><![CDATA[Abstract Aims In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk. Methods and results This study included 1450 consecutive patients with severe AS (aortic valve area <1 cm2 and/or <0.6 cm2/m2) and preserved LVEF and 1645 controls with normal echocardiograms. Patients were stratified in three groups: (i) SVi > 35 mL/m2 or SV > 70 mL; (ii) SVi 30–35 mL/m2 or SV 55–70 mL; and (iii) SVi < 30 mL/m2 or SV < 55 mL. Mortality with medical and surgical management was analysed. Five-year survival was low for SVi < 30 mL/m2 and SV < 55 mL compared to the other groups (all P-values <0.001). After adjustment for outcome predictors, including aortic valve replacement, mortality risk was considerable with SVi < 30 mL/m2 vs. >35 mL/m2 [adjusted hazard ratio (HR) 1.60 (1.17–2.18)] and SV < 55 mL vs. >70 mL [adjusted HR 1.84 (1.32–2.58)]. Similar mortality risk was observed for SVi 30–35 mL/m2 vs. >35 mL/m2 [adjusted HR 1.05 (0.78–1.41)], and for SV 55–70 mL vs. >70 mL [adjusted HR 1.22 (0.94–1.58)]. The prognostic impact of SVi < 30 mL/m2 and SV < 55 mL was consistent in subgroups, including asymptomatic patients and patients with low-gradient severe AS. Conclusion Low flow defined as SVi < 30 mL/m2 or SV < 55 mL is an important outcome predictor in severe AS with preserved LVEF under medical and surgical management. Further studies are needed to prospectively test these values for risk stratification and decision making.]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehy123</identifier><identifier>PMID: 29547988</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Life Sciences</subject><ispartof>European heart journal, 2018-06, Vol.39 (21), p.1992-1999</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. 2018</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-80e85dfb38213c15c5a6bed3a5c8d764e74fcf217faf6ff97fd5ae341500a70d3</citedby><cites>FETCH-LOGICAL-c411t-80e85dfb38213c15c5a6bed3a5c8d764e74fcf217faf6ff97fd5ae341500a70d3</cites><orcidid>0000-0001-7867-3668 ; 0000-0001-5544-9217 ; 0000-0001-9528-2669 ; 0000-0002-2695-9848 ; 0000-0001-9687-0518</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29547988$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://u-picardie.hal.science/hal-03580336$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Rusinaru, Dan</creatorcontrib><creatorcontrib>Bohbot, Yohann</creatorcontrib><creatorcontrib>Ringle, Anne</creatorcontrib><creatorcontrib>Maréchaux, Sylvestre</creatorcontrib><creatorcontrib>Diouf, Momar</creatorcontrib><creatorcontrib>Tribouilloy, Christophe</creatorcontrib><title>Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description><![CDATA[Abstract Aims In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk. Methods and results This study included 1450 consecutive patients with severe AS (aortic valve area <1 cm2 and/or <0.6 cm2/m2) and preserved LVEF and 1645 controls with normal echocardiograms. Patients were stratified in three groups: (i) SVi > 35 mL/m2 or SV > 70 mL; (ii) SVi 30–35 mL/m2 or SV 55–70 mL; and (iii) SVi < 30 mL/m2 or SV < 55 mL. Mortality with medical and surgical management was analysed. Five-year survival was low for SVi < 30 mL/m2 and SV < 55 mL compared to the other groups (all P-values <0.001). After adjustment for outcome predictors, including aortic valve replacement, mortality risk was considerable with SVi < 30 mL/m2 vs. >35 mL/m2 [adjusted hazard ratio (HR) 1.60 (1.17–2.18)] and SV < 55 mL vs. >70 mL [adjusted HR 1.84 (1.32–2.58)]. Similar mortality risk was observed for SVi 30–35 mL/m2 vs. >35 mL/m2 [adjusted HR 1.05 (0.78–1.41)], and for SV 55–70 mL vs. >70 mL [adjusted HR 1.22 (0.94–1.58)]. The prognostic impact of SVi < 30 mL/m2 and SV < 55 mL was consistent in subgroups, including asymptomatic patients and patients with low-gradient severe AS. Conclusion Low flow defined as SVi < 30 mL/m2 or SV < 55 mL is an important outcome predictor in severe AS with preserved LVEF under medical and surgical management. Further studies are needed to prospectively test these values for risk stratification and decision making.]]></description><subject>Life Sciences</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkbFv1DAUhy1ERY_CzoQ8glBaO46dZKyqQiudxNJKbNY751nnw4mD7aS6kf-clJRbmfxkfd-3_Aj5wNklZ624winuEWI-XOH-yEvximy4LMuiVZV8TTaMt7JQqvlxTt6mdGCMNYqrN-S8bGVVt02zIb_v-xFMpsFSH55oyjH8RDoHP_VIw0D7EDN4l4_UDXSE7HDIiT65vKcJZ4xIYSGcWUwcQnKJwtDRMWLCOGNHPdpM50WKzkweIsUDmuyWso3w93hHziz4hO9f3gvy-PX24eau2H7_dn9zvS1MxXkuGoaN7OxONCUXhksjQe2wEyBN09Wqwrqyxpa8tmCVtW1tOwkoKi4Zg5p14oJ8Xrt78HqMrod41AGcvrve6uc_JmTDhFAzX9hPKzvG8GvClHXvkkHvYcAwJV0yXrWSs1ouKFtRE0NKEe2pzZl-HkmfRtLrSIvy8aU-7XrsTsK_VRbgywqEafx_7g-u6aNs</recordid><startdate>20180601</startdate><enddate>20180601</enddate><creator>Rusinaru, Dan</creator><creator>Bohbot, Yohann</creator><creator>Ringle, Anne</creator><creator>Maréchaux, Sylvestre</creator><creator>Diouf, Momar</creator><creator>Tribouilloy, Christophe</creator><general>Oxford University Press</general><general>Oxford University Press (OUP)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-7867-3668</orcidid><orcidid>https://orcid.org/0000-0001-5544-9217</orcidid><orcidid>https://orcid.org/0000-0001-9528-2669</orcidid><orcidid>https://orcid.org/0000-0002-2695-9848</orcidid><orcidid>https://orcid.org/0000-0001-9687-0518</orcidid></search><sort><creationdate>20180601</creationdate><title>Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction</title><author>Rusinaru, Dan ; Bohbot, Yohann ; Ringle, Anne ; Maréchaux, Sylvestre ; Diouf, Momar ; Tribouilloy, Christophe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-80e85dfb38213c15c5a6bed3a5c8d764e74fcf217faf6ff97fd5ae341500a70d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Life Sciences</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rusinaru, Dan</creatorcontrib><creatorcontrib>Bohbot, Yohann</creatorcontrib><creatorcontrib>Ringle, Anne</creatorcontrib><creatorcontrib>Maréchaux, Sylvestre</creatorcontrib><creatorcontrib>Diouf, Momar</creatorcontrib><creatorcontrib>Tribouilloy, Christophe</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rusinaru, Dan</au><au>Bohbot, Yohann</au><au>Ringle, Anne</au><au>Maréchaux, Sylvestre</au><au>Diouf, Momar</au><au>Tribouilloy, Christophe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2018-06-01</date><risdate>2018</risdate><volume>39</volume><issue>21</issue><spage>1992</spage><epage>1999</epage><pages>1992-1999</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract Aims In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk. Methods and results This study included 1450 consecutive patients with severe AS (aortic valve area <1 cm2 and/or <0.6 cm2/m2) and preserved LVEF and 1645 controls with normal echocardiograms. Patients were stratified in three groups: (i) SVi > 35 mL/m2 or SV > 70 mL; (ii) SVi 30–35 mL/m2 or SV 55–70 mL; and (iii) SVi < 30 mL/m2 or SV < 55 mL. Mortality with medical and surgical management was analysed. Five-year survival was low for SVi < 30 mL/m2 and SV < 55 mL compared to the other groups (all P-values <0.001). After adjustment for outcome predictors, including aortic valve replacement, mortality risk was considerable with SVi < 30 mL/m2 vs. >35 mL/m2 [adjusted hazard ratio (HR) 1.60 (1.17–2.18)] and SV < 55 mL vs. >70 mL [adjusted HR 1.84 (1.32–2.58)]. Similar mortality risk was observed for SVi 30–35 mL/m2 vs. >35 mL/m2 [adjusted HR 1.05 (0.78–1.41)], and for SV 55–70 mL vs. >70 mL [adjusted HR 1.22 (0.94–1.58)]. The prognostic impact of SVi < 30 mL/m2 and SV < 55 mL was consistent in subgroups, including asymptomatic patients and patients with low-gradient severe AS. Conclusion Low flow defined as SVi < 30 mL/m2 or SV < 55 mL is an important outcome predictor in severe AS with preserved LVEF under medical and surgical management. Further studies are needed to prospectively test these values for risk stratification and decision making.]]></abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>29547988</pmid><doi>10.1093/eurheartj/ehy123</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7867-3668</orcidid><orcidid>https://orcid.org/0000-0001-5544-9217</orcidid><orcidid>https://orcid.org/0000-0001-9528-2669</orcidid><orcidid>https://orcid.org/0000-0002-2695-9848</orcidid><orcidid>https://orcid.org/0000-0001-9687-0518</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0195-668X
ispartof European heart journal, 2018-06, Vol.39 (21), p.1992-1999
issn 0195-668X
1522-9645
language eng
recordid cdi_hal_primary_oai_HAL_hal_03580336v1
source Oxford University Press Journals All Titles (1996-Current); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection
subjects Life Sciences
title Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T12%3A57%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20low%20stroke%20volume%20on%20mortality%20in%20patients%20with%20severe%20aortic%20stenosis%20and%20preserved%20left%20ventricular%20ejection%20fraction&rft.jtitle=European%20heart%20journal&rft.au=Rusinaru,%20Dan&rft.date=2018-06-01&rft.volume=39&rft.issue=21&rft.spage=1992&rft.epage=1999&rft.pages=1992-1999&rft.issn=0195-668X&rft.eissn=1522-9645&rft_id=info:doi/10.1093/eurheartj/ehy123&rft_dat=%3Cproquest_hal_p%3E2014951075%3C/proquest_hal_p%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2014951075&rft_id=info:pmid/29547988&rft_oup_id=10.1093/eurheartj/ehy123&rfr_iscdi=true