Survival by stroke volume index in low-gradient normal EF severe aortic stenosis: insights into myocardial systolic dysfunction

To the Editor, We read with interest the recent article on survival by stroke volume index (SVI) in patients with low-gradient normal EF severe aortic stenosis, which demonstrated lower SVI is incrementally associated with mortality.1 The authors discuss a putative mechanism of low stroke volume (SV) secondary to concentric remodelling which results in reduced LV cavity size. This impedes LV diastolic filling culminating in diminished systolic function despite normal EF. The authors quote evidence of systolic impairment, for example reduced longitudinal strain, in similar cohorts with preserved EF.2 In the current study, the subgroup with lowest SVI, and therefore presumed most severe systolic impairment despite EF >50%, demonstrated the thickest relative wall measurements. We believe this observation helps to explain the apparent paradox between significant myocardial dysfunction and preservation of EF in this cohort and in the wider ‘heart failure with preserved ejection fraction’ context....

Source: Heart - December 12, 2014 Category: Cardiology Authors: Rodrigues, J. C. L., Dastidar, A. G., Rohan, S., MacIver, D. H. Tags: PostScript Source Type: research