OBJECTIVE To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR). PATIENTS AND METHODS A total of 742 patients from the CoreValve US Pivotal High-Risk Trial randomized to TAVR (n=389) or SAVR (n=353) from February 2011 to September 2012 were stratified by an SVI of 35 mL/m2 and LVEF of 50% for comparing all-cause mortality at 1 year. RESULTS The prevalence of an SVI of less than 35 mL/m2 in patients who underwent TAVR and SAVR was 35.8% (125 of 349) and 31.3% (96 of 307), respectively; LVEF of less than 50% was present in 18.1% (63 of 348) and 19.6% (60 of 306), respectively. Among patients with an SVI of less than 35 mL/m2, 1-year mortality was similar between patients with TAVR and SAVR (16.3% vs 22.2%; P=.25). However, in those with an SVI of 35 mL/m2 or greater, 1-year mortality was lower in those with TAVR than SAVR (10.3% vs 17.3%; P=.03). In patients with an LVEF of less than 50%, mortality was not affected by AVR approach (P>.05). In patients with an LVEF of 50% or higher, TAVR was associated with lower mortality than SAVR when SVI was preserved (9.8% vs 18.6%; P=.01). Mortality was not affected by SVI within the same AVR approach when LVEF was 50% or higher. CONCLUSION In patients with severe aortic stenosis at high risk, there is a significant interaction between AVR approach and the status of SVI and LVEF. When LVEF or SVI was reduced, prognosis was similar regardless of AVR approach. In those with preserved LVEF or SVI, TAVR was associated with a better prognosis than SAVR. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01240902.

中文翻译：

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脑卒中体积指数和左心室射血分数对主动脉瓣置换术后死亡率的影响。

目的为了评估中风量指数（SVI）和左心室射血分数（LVEF）对重度主动脉瓣狭窄患者的预后的影响，比较经导管主动脉瓣置换术（TAVR）和外科手术AVR（SAVR）的患者。患者与方法：2011年2月至2012年9月，来自CoreValve美国关键高危试验的742名患者随机分为TAVR（n = 389）或SAVR（n = 353），其SVI为35 mL / m2和LVEF分层。 50％用于比较1年全因死亡率。结果接受TAVR和SAVR的患者SVI低于35 mL / m2的患病率分别为35.8％（349例中的125例）和31.3％（307例中的96例）。LVEF低于50％的比例分别为18.1％（348中的63）和19.6％（306中的60）。在SVI低于35 mL / m2的患者中，TAVR和SAVR患者的1年死亡率相似（16.3％对22.2％； P = .25）。但是，在SVI为35 mL / m2或更高的患者中，TAVR患者的1年死亡率低于SAVR（10.3％比17.3％； P = .03）。LVEF低于50％的患者，死亡率不受AVR方法的影响（P> .05）。LVEF为50％或更高的患者，保留SVI后，TAVR的死亡率低于SAVR（9.8％vs 18.6％； P = .01）。当LVEF为50％或更高时，在相同的AVR方法中，死亡率不受SVI的影响。结论在高风险的严重主动脉瓣狭窄患者中，AVR方法与SVI和LVEF的状态之间存在显着的相互作用。当LVEF或SVI降低时，无论采用AVR方法如何，预后都是相似的。在那些保留了LVEF或SVI的人中，与SAVR相比，TAVR的预后更好。试验注册临床试验.gov标识符：NCT01240902。