PROGNOSTIČKI ZNAČAJ INDEKSIRANOG UDARNOG VOLUMENA KOD ASIMPTOMATSKIH PACIJENATA SA UMERENOM DO TESNOM AORTNOM STENOZOM I OČUVANOM EJEKCIONOM FRAKCIJOM LEVE KOMORE

Srdjan Aleksandric; Nina Miljkovic; Sara Tomovic; Stefan; Aleksandra Djokovic; Nikola Boskovic; Srdjan Dedic; Marina Ostojic; Marija Ristic; Ivan; Katarina Zivic; David sarenac; Tomislav Smiljkovic; Lidija  Pantic; Anja Bogovic; Anja Stanojlovic; Vojislav Giga; Ivana Nedeljkovic; Marko Banovic; Ivan Soldatovic

doi:10.5937/medi0-59653

Srdjan Aleksandric University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0000-0001-6903-4477
Nina Miljkovic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0006-4638-6852
Sara Tomovic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0005-9999-7641
Stefan University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0000-0002-3045-5263
Aleksandra Djokovic University of Belgrade, Faculty of Medicine, University Hospital Medical Center "Bezanijska kosa", Belgrade, Serbia https://orcid.org/0000-0002-6094-7306
Nikola Boskovic Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia https://orcid.org/0000-0001-8987-4190
Srdjan Dedic University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0000-0001-5610-7083
Marina Ostojic University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0000-0002-2448-1799
Marija Ristic University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0009-0005-5768-3003
Ivan University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0007-3902-5853
Katarina Zivic University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0009-0001-1540-1072
David sarenac University Clinical Center of Serbia, Clinic of Cardiology, Belgrade, Serbia https://orcid.org/0009-0000-5798-0423
Tomislav Smiljkovic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0009-7629-5857
Lidija Pantic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0000-4859-5873
Anja Bogovic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0003-8932-9303
Anja Stanojlovic University of Belgrade, Faculty of Medicine, Belgrade, Serbia https://orcid.org/0009-0009-0977-6490
Vojislav Giga University of Belgrade, Faculty of Medicine, University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia https://orcid.org/0000-0003-1049-6321
Ivana Nedeljkovic University of Belgrade, Faculty of Medicine, University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia https://orcid.org/0000-0001-5552-773X
Marko Banovic University of Belgrade, Faculty of Medicine, University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia https://orcid.org/0000-0002-0017-6140
Ivan Soldatovic University of Belgrade, Faculty of Medicine, Institute of Medical Statistics and Informatics, Belgrade, Serbia https://orcid.org/0009-0001-1540-1072

DOI: https://doi.org/10.5937/medi0-59653

Keywords: aortic stenosis; asymptomatic, stroke volume; stroke volume index; Doppler echocardiography; outcome

Abstract

Introduction and aim: Whether and when to intervene in asymptomatic patients with moderate to severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) has not yet been determined. In patients with AS, low flow through the aortic valve is defined as indexed stroke volume (SVi) ≤35ml/m². The aim of our work was to determine the relationship between SVi and all-cause mortality, as well as the prognostic significance of low SVi in asymptomatic patients with moderate to severe AS, high mean gradient across (P_mean) the aortic valve and preserved LVEF.

Methods: The study included 121 asymptomatic patients (69 men, mean age 66±11 years) with moderate-to-severe AS (aortic valve area ≤1.5cm²), high P_mean across the aortic valve and preserved LVEF. The median follow-up was 38 months (IQR 35-42 months).

Results: Ten patients (8%) died during the follow-up. All-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m² compared with those with SVi >35ml/m² (15% vs. 4%, p<0.045). The cumulative incidence of all-cause mortality was significantly higher in the group of AS-patients with SVi ≤35ml/m² compared with those with SVi >35ml/m² (log-rank p-value 0.035). After adjustment for outcome predictors, SVi was found to be the most significant predictor of all-cause mortality in the mid-term follow-up (adjusted-HR: 0.870; 95%CI: 0.801–0.945; p=0.001).

Conclusion: The left ventricular SVi is an important predictor of all-cause mortality in asymptomatic patients with moderate-to-severe AS, high P_mean across the aortic valve, and preserved LVEF.

PROGNOSTIC SIGNIFICANCE OF INDEXED STROKE VOLUME IN ASYMPTOMATIC PATIENTS WITH MODERATE TO SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Abstract