Bahlmann Edda, Gerdts Eva, Einarsen Eigir, Midtbø Helga, Pedersen Eva R, Rossebø Anne, Willems Stephan, Cramariuc Dana
Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, Hamburg 20099, Germany.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Eur Heart J Cardiovasc Imaging. 2025 Jan 31;26(2):280-286. doi: 10.1093/ehjci/jeae272.
Sex-specific low flow was recently defined as stroke volume index (SVi) ≤ 40 mL/m² in men and ≤32 mL/m² in women. We tested the prognostic association of these cut-offs in patients with aortic stenosis (AS) with concordantly and discordantly graded AS [concordantly graded AS by energy loss (CGASEL) and discordantly graded AS by energy loss (DGASEL)] based on pressure recovery adjusted aortic valve area [energy loss (EL)].
Data from 1351 patients with asymptomatic AS, peak jet velocity <4 m/s, and preserved left ventricular ejection fraction enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study were used. DGASEL was defined as EL <1.0 cm² with mean aortic gradient <40 mmHg and CGASEL as EL ≥1.0 cm² with mean aortic gradient <40 mmHg. Patients were further grouped into normal and low flow. The outcome was combined all-cause death and hospitalization for heart failure (HF). CGASEL with normal/low flow was present in 915/253 patients, and DGASEL with normal/low flow was present in 57/126 patients. During a median follow-up of 4.3 years, event-free survival was lower in patients with DGASEL irrespective of flow compared to CGASEL with normal flow (P < 0.05). In Cox regression analysis, DGASEL with normal or low flow were both associated with increased risk of all-cause death and hospitalization for HF after adjustment for age, sex, heart rate, randomized study treatment, hypertension, aortic valve replacement, and aortic valve calcification (P < 0.05). No survival difference was found between patients with normal vs. low flow within groups of DGASEL or CGASEL.
Identification of low flow by the proposed sex-specific thresholds of SVi needs more prognostic validation before application in clinical practice.
CLINICALTRIALS.GOV IDENTIFIER: NCT00092677.
性别特异性低流量最近被定义为男性每平方米体表面积的每搏输出量指数（SVi）≤40 mL/m²，女性≤32 mL/m²。我们基于压力恢复调整后的主动脉瓣面积[能量损失（EL）]，测试了这些临界值在主动脉瓣狭窄（AS）患者中与能量损失分级一致和不一致的AS患者[能量损失分级一致的AS（CGASEL）和能量损失分级不一致的AS（DGASEL）]中的预后相关性。
使用了在主动脉瓣狭窄研究中纳入的1351例无症状AS、峰值射流速度<4 m/s且左心室射血分数保留的患者的数据。DGASEL被定义为EL<1.0 cm²且平均主动脉瓣压差<40 mmHg，CGASEL被定义为EL≥1.0 cm²且平均主动脉瓣压差<40 mmHg。患者进一步分为正常流量和低流量组。结局为全因死亡和心力衰竭（HF）住院的综合情况。915/253例患者存在正常/低流量的CGASEL，57/126例患者存在正常/低流量的DGASEL。在中位随访4.3年期间，与正常流量的CGASEL相比，无论流量如何，DGASEL患者的无事件生存率均较低（P<0.05）。在Cox回归分析中，调整年龄、性别、心率、随机研究治疗、高血压、主动脉瓣置换和主动脉瓣钙化后，正常或低流量的DGASEL均与全因死亡和HF住院风险增加相关（P<0.05）。在DGASEL或CGASEL组中，正常流量与低流量患者之间未发现生存差异。
在临床实践中应用之前，通过提议的性别特异性SVi阈值识别低流量需要更多的预后验证。
NCT00092677。
