Impact of stroke volume on severe aortic stenosis in patients with normal left ventricular function

Background Low-flow (LF) aortic stenosis (AS) with a normal ejection fraction reportedly has a worse prognosis than normal-flow (NF) AS. We assessed whether the stroke volume affects early- and long-term survival of patients with AS undergoing aortic valve replacement. Methods and results From 2007 to 2016, 179 patients with AS and a normal ejection fraction (>= 50%) and without other valve diseases were divided into two groups according to the stroke volume index (SVI): NF group (SVI >= 35 ml/m(2), n = 167) and LF group (SVI < 35 ml/m(2), n = 12). Early- and long-term survival was compared between the two groups. Preoperative echocardiography showed that the end-diastolic diameter and aortic valve area were smaller in the LF than NF group (43 +/- 1.9 vs. 48 +/- 0.4 mm, p < 0.005 and 0.33 +/- 0.14 vs. 0.49 +/- 0.14 cm(2)/m(2), p < 0.0005, respectively). Hospital mortality was significantly higher (16.7% vs. 1.8%, p < 0.05) and 5-year overall survival was lower (58 +/- 17 vs. 84 +/- 4.2 months, p < 0.005) in the LF than NF group. Conclusion Patients with LF AS had worse operative and long-term outcomes than those with NF, even though they had preserved LV function.