1. Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2.
- Author
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Taniguchi T, Morimoto T, Takeji Y, Shirai S, Ando K, Tabata H, Yamamoto K, Murai R, Osakada K, Sakamoto H, Tada T, Murata K, Obayashi Y, Amano M, Kitai T, Izumi C, Toyofuku M, Kanamori N, Miyake M, Nakayama H, Izuhara M, Nagao K, Nakatsuma K, Furukawa Y, Inoko M, Kimura M, Ishii M, Usami S, Nakazeki F, Shirotani M, Inuzuka Y, Ono K, Minatoya K, and Kimura T
- Subjects
- Humans, Male, Female, Aged, Risk Factors, Aged, 80 and over, Time Factors, Treatment Outcome, Risk Assessment, Frailty diagnosis, Frailty physiopathology, Frailty epidemiology, Comorbidity, Japan epidemiology, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis surgery, Registries, Ventricular Function, Left, Stroke Volume, Severity of Illness Index, Aortic Valve physiopathology, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve pathology, Heart Failure physiopathology, Heart Failure mortality, Heart Failure therapy, Calcinosis physiopathology, Calcinosis mortality, Calcinosis diagnostic imaging, Hemodynamics
- Abstract
Background: Low-gradient (LG) aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS in terms of cardiac damage, frailty, aortic valve calcification, and clinical outcomes., Objectives: The aim of this study was to compare the clinical characteristics and outcomes between each hemodynamic type of LG AS and HG AS., Methods: The current study included 3,363 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) Registry-2 after excluding patients without indexed stroke volume or left ventricular ejection fraction (LVEF) data. Patients were divided into 4 groups (LG AS with reduced LVEF: n = 285; paradoxical low flow, low gradient [LFLG]: n = 220; normal flow, low gradient [NFLG]: n = 872; HG: n = 1,986)., Results: Compared with HG AS, LG AS with reduced LVEF more often had cardiovascular comorbidities, advanced cardiac damage, and frailty with less severe valve calcification and paradoxical LFLG AS more often had atrial fibrillation, advanced cardiac damage, and frailty with less severe valve calcification, while NFLG AS had comparable cardiac damage and frailty with less severe valve calcification. Cumulative 3-year incidence of death or heart failure hospitalization was higher in LG AS with reduced LVEF and paradoxical LFLG than in HG AS. After adjusting for confounders, LG AS with reduced LVEF and paradoxical LFLG compared with HG AS were independently associated with higher risk for death or heart failure hospitalization (HR: 1.82; 95% CI: 1.49-2.23; P < 0.001; and HR: 1.43; 95% CI: 1.13-1.82; P = 0.003, respectively) but NFLG AS was not (HR: 1.03; 95% CI: 0.88-1.21; P = 0.68)., Conclusions: Clinical outcomes were significantly worse in LG AS with reduced LVEF and paradoxical LFLG AS and comparable in NFLG AS compared with HG AS., Competing Interests: Funding Support and Author Disclosures This work was supported by an educational grant from the Research Institute for Production Development (Kyoto, Japan). Dr Shirai has served as a clinical proctor for Edwards Lifesciences, Medtronic, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025. Published by Elsevier Inc.)
- Published
- 2025
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