Abstract 13803: Integration of Stroke Volume Index Into Clinical Decision Making for Patients With Suspected Severe Aortic Stenosis and Preserved Ejection Fraction: A Systematic Review of Evidence and Meta-Analysis
Introduction: The 2014 ACC/AHA valvular disease guidelines recommend estimation of stroke volume index (SVI) by echocardiography in patients with suspected low-gradient severe aortic stenosis (SAS) and preserved left ventricular ejection fraction. We explored the evidence base for this recommendation by comparing the natural history of the disease in subgroups of low gradient aortic stenosis patients with high gradient patients.
Methods: Pubmed, Embase and Scopus databases were searched for all studies that have compared natural history of SAS with preserved LVEF in flow-gradient patterns. We studied the following 3 groups: high gradient (HG), low-flow low-gradient (LFLG), and normal-flow low-gradient (NFLG). Random effects model was used to pool individual study results. The end-point was long-term all-cause mortality.
Results: A total of 7 studies with 3,954 patients fulfilled the criteria. Compared to HG SAS, both LFLG and NFLG patients had a higher burden of comorbidities such as atrial fibrillation, coronary artery disease, and hypertension. Also, end-diastolic volume index was smaller for LFLG patients and indexed aortic valve area larger for NFLG patients. All-cause mortality was similar between HG and LFLG groups [Relative risk (RR): 1.27, 95% confidence interval (CI): 0.85 -1.91, p=0.24], while patients with NFLG had significantly lower all-cause mortality compared to HG group [RR: 0.63, 95% CI: 0.44-0.89, p=0.009].
Conclusions: Compiled evidence supports using SVI in patients with suspected low gradient SAS. All analyses revealed high heterogeneity and further high-quality studies are necessary.
Author Disclosures: C. Bavishi: None. K. Balasundaram: None. E. Argulian: None.
- © 2015 by American Heart Association, Inc.