Non Invasive Cardiology Unit, Leviev Heart Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
Non Invasive Cardiology Unit, Leviev Heart Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Hashomer, Israel.
Am J Cardiol. 2014 Aug 1;114(3):449-55. doi: 10.1016/j.amjcard.2014.05.014. Epub 2014 May 16.
The aim of the present study was to evaluate whether assessment of stroke volume index (SVI) can be used to improve risk stratification among patients with low-gradient severe aortic stenosis and preserved ejection fraction (EF). Study population comprised 409 patients with aortic valve area ≤1.00 cm(2), mean gradient <40 mm Hg, and a normal EF (≥50%) who were followed up in a tertiary referral center from 2004 to 2012. Echocardiographic parameters and clinical data were collected. Multivariate Cox proportional hazards regression modeling was used to evaluate the association between SVI and the risk of all-cause mortality. Mean age of study patients was 78 ± 11 years, and 42% were men. The mean SVI was 39 ± 7 ml/m(2) (tertile 1 = 32 ± 4 ml/m(2); tertile 2 = 39 ± 1 ml/m(2); tertile 3 = 47 ± 4 ml/m(2)). Multivariate analysis showed that the SVI was the most powerful echocardiographic parameter associated with long-term outcome: each 5 ml/m(2) reduction in SVI was associated with a 20% increase in adjusted mortality risk (p = 0.01). Consistently, Kaplan-Meier analysis showed that the cumulative probability of survival during 3 years of follow-up was 60%, 72%, and 73% among patients in the low-, intermediate-, and high-SVI groups, respectively (p = 0.012). Our findings suggest that in patients with low-gradient severe aortic stenosis and preserved EF, there is a graded inverse relation between SVI and the risk of long-term mortality.
本研究旨在评估评估每搏量指数（SVI）能否用于改善射血分数保留的低梯度重度主动脉瓣狭窄患者的风险分层。研究人群包括 2004 年至 2012 年在三级转诊中心随访的 409 名主动脉瓣面积≤1.00cm²、平均梯度<40mmHg 和正常射血分数（≥50%）的患者。收集了超声心动图参数和临床数据。采用多变量 Cox 比例风险回归模型评估 SVI 与全因死亡率风险的关系。研究患者的平均年龄为 78±11 岁，42%为男性。平均 SVI 为 39±7ml/m²（第 1 三分位数=32±4ml/m²；第 2 三分位数=39±1ml/m²；第 3 三分位数=47±4ml/m²）。多变量分析表明，SVI 是与长期预后最相关的超声心动图参数：SVI 每降低 5ml/m²，校正死亡率风险增加 20%（p=0.01）。一致地，Kaplan-Meier 分析显示，在 3 年随访期间，低、中、高 SVI 组患者的累积生存率分别为 60%、72%和 73%（p=0.012）。我们的研究结果表明，在射血分数保留的低梯度重度主动脉瓣狭窄患者中，SVI 与长期死亡率风险之间呈分级反比关系。
