The Small Left Ventricle is an Important Predictor of Clinical Outcomes In Severe Aortic Stenosis

Calcific aortic stenosis (AS) is the most common valvular heart disease requiring invasive intervention. While the implantation of an artificial heart valve restores normal intracardiac hemodynamics, baseline left ventricular (LV) parameters can significantly influence both early and long-term postoperative outcomes. It is well-established that patients with LV dilation experience worse outcomes after surgical or transcatheter treatment of severe AS compared to those with normal LV dimensions. However, the impact of reduced LV volume remains insufficiently explored. This study aims to investigate the effect of small LV dimensions on clinical outcomes in the management of severe high-gradient AS, based on existing literature. We conducted a scoping review using PubMed, Google Scholar, and Elibrary databases. Articles published between 2015 and 2024 were included, though earlier publications were also referenced to support specific sections. Both original research articles and systematic reviews were examined. The central focus of this study is to investigate the impact of small LV size on clinical outcomes in patients undergoing treatment for severe high-gradient AS. According to the existing literature, small LV size is associated with significantly higher 30-day and 2-year all-cause mortality (20.8% vs. 14.3%; adjusted HR, 1.58 [95% CI, 1.20–2.09]; p = 0.0013) and cardiovascular mortality (8.8% vs. 5.5%; adjusted HR, 1.93 [95% CI, 1.25–2.98]; p = 0.0028). Furthermore, considerable emphasis has been placed on the low transvalvular flow (low flow–high gradient) pattern, which represents a critical predictor of clinical outcomes in severe AS. Notably, the 2-year cardiovascular event-free survival rate in patients exhibiting the low flow–high gradient pattern is 30 ± 12%. These findings underscore the importance of LV size and flow patterns in prognostic assessments and therapeutic decision-making for severe AS. The authors emphasize that these patterns require further investigation for early identification and minimization of perioperative risks, determination of optimal timing for surgical or transcatheter intervention, and improvement of prognosis for patients following treatment of severe aortic stenosis.