Stroke volume index
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Stroke Volume Index: Insights from Recent Research
Predictive Value of Stroke Volume Variation in Surgery and ICU Settings
Stroke Volume Variation (SVV) in Cardiac and Thoracic Surgery
Stroke volume variation (SVV) has been extensively studied for its ability to predict fluid responsiveness in patients undergoing cardiac and thoracic surgery. A systematic review and meta-analysis encompassing 20 studies with 854 patients revealed that SVV has good predictive performance in cardiac surgery and ICU settings, with pooled sensitivity and specificity values of 0.71 and 0.76, respectively, for cardiac surgery, and 0.85 for both metrics in the ICU post-cardiac surgery group. However, its predictive performance in thoracic surgery was moderate, with sensitivity and specificity values of 0.73 and 0.62, respectively.
Stroke Volume Index as a Risk Marker in Aortic Stenosis
Low Stroke Volume Index (SVi) in High-Gradient Aortic Stenosis (HG-AS)
In patients with high-gradient aortic stenosis (HG-AS) undergoing transcatheter aortic valve replacement (TAVR), low stroke volume index (SVi ≤ 35 mL/m²) has been identified as a significant risk marker. A study involving 476 patients found that those with low SVi had higher levels of NT-proBNP and smaller indexed valve areas. These patients also exhibited a higher incidence of adverse outcomes, including all-cause mortality and heart failure readmission within one year, particularly in those with reduced left ventricular (LV) function.
Hemodynamic Classification in Severe Aortic Stenosis
Transvalvular Flow Rate vs. Stroke Volume Index
Recent research suggests that transvalvular flow rate (FR), calculated as stroke volume divided by left ventricular ejection time, may be a more accurate marker of transvalvular flow in severe aortic stenosis compared to the traditional stroke volume index (SVi). This finding could lead to a new hemodynamic classification for aortic stenosis, potentially improving patient outcomes by better identifying those at risk.
Stroke Volume Index in Exercise Physiology
Regulation During Submaximal and Maximal Exercise
In healthy individuals, stroke volume index (SVi) increases significantly during submaximal exercise due to increased left ventricular filling pressure and end-diastolic volume. However, during maximal exercise, further increases in cardiac output are driven primarily by heart rate, as SVi plateaus. This dynamic highlights the importance of SVi in understanding cardiovascular responses to varying levels of physical exertion.
Stroke Volume Index in Fluid Responsiveness
Assessment in Patients with Reduced Cardiac Function
Monitoring stroke volume variation (SVV) can effectively predict fluid responsiveness in patients with reduced left ventricular function post-cardiac surgery. A study demonstrated that SVV correlates significantly with changes in stroke volume index (SVi) following volume loading, making it a valuable tool for real-time hemodynamic assessment in these patients.
Conclusion
Stroke volume index (SVi) and stroke volume variation (SVV) are critical metrics in various clinical settings, from predicting fluid responsiveness in surgical and ICU patients to assessing risk in aortic stenosis and understanding cardiovascular responses during exercise. These insights underscore the importance of SVi and SVV in optimizing patient care and outcomes across different medical disciplines.
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