Prognostic implications of paradoxical low gradient severe aortic stenosis: a comprehensive analysis from a large multicentric registry

Abstract Background Up to 40% of patients with severe aortic stenosis (SAS; indexed valve area (AVAi) <0.6 cm2/m2) present low transvalvular mean gradient (MG) despite a normal left ventricular ejection fraction (EF). There is intense debate about the prognostic significance such entity, some referring it as an advanced form disease, others intermediate between moderate and form. Objectives To compare outcome paradoxical SAS (PLG-SAS; i.e., <40 mmHg AVAi vs. (MAS; i.e. >0.6 high (HG-SAS; >40 cm2/m2). Methods 2582 consecutive (PLG-SAS, n=933; MAS, n=876 HG-SAS, n=773) preserved EF (>50%) from international multicentric registry were studied. Five years mortality groups was compared using Kaplan Meier analysis. Inverse probability weighting used adjust for clinical imaging baseline characteristics. Additionally, explore impact MG (<40 mmHg) in cm2/m2 (PLG-SAS HG-SAS) (<0.6 vs MAS) we performed 2 different propensity score analyses. Patients censored at time surgery. Results Overall, during 23 [IQR,10–47] months follow-up 1003 died 770 underwent replacement. IPW-adjusted natural history significantly better PLG-SAS worst HG-SAS (59 47 41%, p<0.001, see Figure 1A). Furthermore, equal (448 pairs), survival MAS (54% 39% 1B) (377 (43% 32% 1C). Conclusions In this large cohort, than that worse patients. comparable gradient, smaller calculated AVAi, prognosis whereas higher prognosis. Taking together, these data demonstrate disease continuum, being most malignant AS. Funding Acknowledgement Type funding sources: Public grant(s) – National budget only. Main source(s): Fonds de la Recherche Scientifique (F.R.S.–FNRS)