{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:41:21Z","timestamp":1747147281254,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Blunted left ventricular hemodynamics reflected by a low stroke volume index (SVI) \u226435\u2009mL\/m<jats:sup>2<\/jats:sup> body surface area (low flow [LF]) in patients with severe aortic stenosis (AS) are associated with worse outcomes even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients can have a low or high transvalvular mean pressure gradient (MPG). We investigated the impact of the pre\u2010interventional MPG on outcomes after TAVI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with LF AS were classified into those with normal (EF\u2009\u2265\u200950%; LF\/NEF) or reduced ejection fraction (EF\u2009&lt;\u200950%; LF\/REF) and were then stratified according to an MPG\u2009&lt;\u2009or\u2009\u2265\u200940\u2009mmHg. Patients with SVI &gt;35\u2009mL\/m<jats:sup>2<\/jats:sup> (normal flow; NF) served as controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>597 patients with LF\/NEF, 264 patients with LF\/REF and 975 patients with NF were identified. Among all groups those patients with a low MPG were characterized by higher cardiovascular risk. In patients with LF\/REF, functional improvement post\u2010TAVI was less pronounced in low\u2010MPG patients. One\u2010year survival was significantly worse in LF AS patients with a low vs. high MPG (LF\/NEF 16.5% vs. 10.5%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.022; LF\/REF 25.4% vs. 8.0%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.002), whereas no differences were found in NF patients (8.7% vs. 10.0%, <jats:italic>p<\/jats:italic>\u00a0=\u20090.550). In both LF AS groups, a low pre\u2010procedural MPG emerged as an independent predictor of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with LF AS, an MPG cut\u2010off of 40\u2009mmHg defines two patient populations with fundamental differences in outcomes after TAVI. Patients with LF AS and a high MPG have the same favorable prognosis as patients with NF AS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29840","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T12:59:23Z","timestamp":1623934763000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of echocardiographic mean transvalvular gradients in patients with aortic stenosis and low flow undergoing transcatheter aortic valve implantation"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7825-2799","authenticated-orcid":false,"given":"Ulrich","family":"Fischer\u2010Rasokat","sequence":"first","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"Justus\u2010Liebig\u2010Universit\u00e4t Gie\u00dfen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Renker","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"Department of Cardiac Surgery Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) Partner Site RheinMain  Frankfurt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Liebetrau","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) Partner Site RheinMain  Frankfurt Germany"},{"name":"Medical Clinic I (Cardiology and Angiology) University Hospital of Giessen  Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maren","family":"Weferling","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Rolf","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) Partner Site RheinMain  Frankfurt Germany"},{"name":"Medical Clinic I (Cardiology and Angiology) University Hospital of Giessen  Giessen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirko","family":"Doss","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Kerckhoff Heart Center  Bad Nauheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian W.","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kerckhoff Heart Center  Bad Nauheim Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) Partner Site RheinMain  Frankfurt Germany"},{"name":"Medical 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