Benefit of Transcatheter Aortic Valve Replacement in Patients With Paradoxical Low-Flow Low-Gradient Versus High-Gradient Aortic Stenosis and Preserved Left Ventricular Function

Background: There is conflicting data regarding transcatheter aortic valve replacement in patients with paradoxical low-flow, low-gradient stenosis (pLFLG-AS). The authors aimed to examine the hemodynamic and clinical benefit of symptomatic pLFLG-AS compared high-gradient severe AS. Methods: A single-center retrospective analysis who underwent using a transfemoral approach was performed. Patients mean gradient ≥40 mm Hg were included (HG-AS) group (n=217). <40 Hg, Vmax <4.0 m/s, stroke volume index ≤35 mL/m 2 (n=73). Clinical end points including treatment futility, survival, changes functional status quality life, echocardiographic outcomes left ventricular reverse remodeling evaluated. Two primary composite used for futility. first as outcome defined death or New York Heart Association class III/IV at 1 year. second Kansas City Cardiomyopathy Questionnaire 12 score ≤25 Results: no differences mortality, Questionnaire-based futility (HG-AS: 8.8% versus pLFLG-AS: 6.1%; P =0.482), Association-based 9.1% 11.6%; =0.546) Both groups had similar improvement when baseline 88.56±12.38% 137.24±31.75%; =0.382). relative interval decrease proportion 53.6% 55.1%; =0.838). Echocardiographic evidence ventricle documented by improvements global longitudinal strain (pre: −13.95±0.36% post: −14.83±0.38%, =0.004) 30 days. Conclusions: did not confer worse prognosis. Mortality rate year both groups. Left apparent.