Interaction of stroke volume and myocardial phenotype in patients with severe aortic stenosis referred for intervention: outcome data from the BSCMR AS700 study

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf The BSCMR Valve Consortium Background Patients with low-flow aortic stenosis (LF-AS) have higher mortality than those high-flow severe AS. conventional echocardiographic definition LF-AS is an indexed stroke volume (SVi) <35ml/m2. Whether this cut-off translates to cardiac magnetic resonance (CMR), and how CMR SVi associates myocardial remodelling (volume/function/scar) survival unclear. Purpose To determine the association between SVi, in symptomatic Methods In a multi-centre longitudinal outcome study patients AS listed for either surgical (SAVR) or transcatheter valve intervention (TAVI) at six cardiothoracic centres, was assessed stratified by SVi. underwent preprocedural echocardiography January 2003 May 2015. Standardised core-lab analyses on pre-procedural biventricular volumes, function scar quantification were performed. All-cause cardiovascular tracked minimum two years after AVR. Results A total 674 (age 75 ± 14years; 63% male, area 0.4 0.1 cm2/m2) included. low <35ml/m2 older had greater burden comorbidities (atrial fibrillation [AF], diabetes, high BMI). Independent predictors age, AF, increased left atrial volume, regurgitant fraction ventricular mass (LV) index (by CMR). There no difference choice (TAVI vs SAVR) presence late gadolinium enhancement. multivariate analysis (Table 1), associated whole cohort (HR 0.97, 95%CI 0.95-0.99, p = 0.02), all-cause TAVI 0.006) but not SAVR (p 0.6). Adjusted hazard increases below 50ml/m2 plateaus 35-40ml/m2 (Figure 1A), adjusted LGE, STS score (Society Thoracic Surgery score) wall thickness. Conclusion independent predictor mortality. Mortality progressively 50mL/m2. Figure 1