Download Lower left ventricular stroke volume predicts cardiovascular events

Lower left ventricular stroke volume predicts cardiovascular
events in asymptomatic aortic stenosis (the SEAS study)
Mai Tone Lønnebakken 1,2, Dana Cramariuc 2, Kurt Boman 3, Anne B. Rossebø 4, Kenneth Egstrup 5, Simon Ray 6,
Christa Gohlke-Baerwolf 7, Eva Gerdts 1,2
Institute of Medicine, University of Bergen , Norway 1, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway 2, Skelleftea Hospital, Department of
Medicine, Skelleftea, Sweden 3, , University of Oslo, Aker University Hospital, Department of Cardiology, Oslo, Norway 4 , Svendborg Hospital, Department of Cardiology,
Svendborg, Denmark 5 , Manchester Academic Sciences Centre, Manchester, United Kingdom 6 , Heart Centre Bad Krozingen, Bad Krozingen, Germany 7
Background:
Results:
•Mean aortic gradient is used to assess aortic
stenosis (AS) severity and cardiovascular
(CV) risk
•During follow-up, a total of 631 CV events
occurred (Table 1)
•In Kaplan Meier plot, low SVI was associated
with higher rate of CV events (Figure 1)
•Lower SVI at baseline was associated with
older age, lower mean aortic gradient and
lower LV mass (p<0.01)
•In time-varying Cox regression analysis lower
SVI at baseline and during follow-up both
predicted higher rate of CV events
independent of mean aortic gradient (Table 2)
•Theoretically, reduced lower left ventricular
(LV) stroke volume may cause a reduction in
mean aortic gradient and consequently an
underestimation of CV risk
•The aim of the study was to assess the
added prognostic information by including LV
stroke volume in follow-up of AS
Methods:
•1752 patients with mild-moderate AS included
in the Simvastatin and Ezetimibe in Aortic
Stenosis (SEAS) study
•Stoke volume derived from Doppler
echocardiography and index for height2.04
(SVI) from baseline and annual follow-up visits
with a mean follow-up of 4.3 years
Table 1 Clinical characteristics
Variables
N= 1752
Age (years)
67±10
CV events
631 (36%)
•The primary study end-point was major CV
events including CV death, aortic valve events
and ischemic CV events
Log Rank 14.6 (p<0.01)
SVI<22ml/m2.04
SVI baseline
(ml/m2.04)
LV mass (g)
N=222
28.6±8.2
SVI ≥22ml/m2.04
195±68
N=1530
LV Ejection fraction (%)
66±7
Mean aortic gradient (mmHg)
23±9
Table 2 Time-dependent Cox Regression Analysis
HR (95% CI)
•Low SVI was defined as <22 ml/m 2.04
•The prognostic impact of SVI was tested by
Kaplan Meier plot and Cox regression analysis
reporting Hazard ratio (HR) and 95%
confidence intervals (CI)
Figure 1 Low SVI predicted higher CV event rate
SVI* (ml/m2.04)
1.016(1.006-1.026)**
Mean aortic gradient* (mmHg)
1.021(1.017-1.026)**
LV mass* (g)
1.002(1.001-1.003)**
Study treatment
1.051(0.898-1.230)
Baseline SVI (ml/m2.04)
1.014(1.002-1.026)*
* p<0.05, ** p<0.01
Conclusion:
During follow-up of patients with
asymptomatic AS, lower baseline LV
SVI or reduction in LV SVI both
predicts higher rates of CV events
independent of AS severity
Disclosures: KB, ABR, KE, SR, CGB and EG were members of
the Scientific Steering Committee in the SEAS study and received
honoraria from Merck Schering Plough, the sponsor of the study