{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:01:02Z","timestamp":1771225262396,"version":"3.50.1"},"reference-count":6,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Transaortic flow rate (TFR, mL\/s) is an emerging hemodynamic index in aortic stenosis (AS), offering insights beyond stroke volume index (SVi). We evaluated the hemodynamic determinants and prognostic significance of TFR at rest and peak dobutamine stress in patients with suspected low\u2010flow, low\u2010gradient (LF\u2010LG) AS and reduced left ventricular ejection fraction (LVEF\u2009<\u200950%).<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n This study aimed to assess and compare the hemodynamic determinants of TFR at rest and during peak pharmacological stress, and to evaluate their association with 3\u2010year survival.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Among 86 patients undergoing dobutamine stress echocardiography (DSE), 34 were classified as true severe, eight as pseudo\u2010severe, and 44 as indeterminate AS. TFR and associated parameters were assessed at rest and stress, and survival was evaluated at 3 years.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At rest, no significant between\u2010group differences in TFR were observed (\n p<\/jats:italic>\n \u2009=\u20090.11). However, at peak stress, TFR differed significantly between groups: true severe (226\u2009\u00b1\u200962\u2009mL\/s), pseudo\u2010severe (334\u2009\u00b1\u200955\u2009mL\/s), and indeterminate (248\u2009\u00b1\u200967\u2009mL\/s;\n p<\/jats:italic>\n \u2009<\u20090.01). Rest TFR was independently associated with cardiac output (CO), arterial compliance, and valvulo\u2010arterial impedance (ZVA). During stress, TFR was predominantly associated with CO, although systemic vascular properties remained significant in pseudo\u2010severe AS. Flow reserve (\u0394TFR) was influenced only by stress\u2010derived variables. At 3\u2010year follow\u2010up, stress TFR was a significant predictor of survival (\n p<\/jats:italic>\n \u2009=\u20090.03), independent of AS classification (\n p<\/jats:italic>\n \u2009=\u20090.04) and intervention (\n p<\/jats:italic>\n \u2009=\u20090.04). A stress TFR\u2009>\u2009195\u2009mL\/s was the optimal survival threshold (AUC 0.64; sensitivity 85%, specificity 70%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These findings suggest that stress TFR reflects left ventricular contractile reserve and carries prognostic value in LF\u2010LG AS. Stress\u2010based assessment may enhance clinical decision\u2010making, particularly in diagnostically ambiguous AS subsets.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ccd.70029","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T05:31:16Z","timestamp":1754371876000},"page":"2386-2390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Re\u2010Exploration of Flow Rate in Low\u2010Flow, Low\u2010Gradient Aortic Stenosis"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0040-7719","authenticated-orcid":false,"given":"Sara","family":"Hungerford","sequence":"first","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"},{"name":"Faculty of Health and Medicine The University of Sydney Sydney Australia"},{"name":"The CardioVascular Center Tufts Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-785X","authenticated-orcid":false,"given":"Eleanor","family":"Rye","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hari","family":"Sritharan","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Choong","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravinay","family":"Bhindi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal North Shore Hospital Sydney Australia"},{"name":"Faculty of Health and Medicine The University of Sydney Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.02.046"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.05.008"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab045"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeae331"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051200"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.018"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70029","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70029","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:01:33Z","timestamp":1771221693000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":6,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccd.70029"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70029","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"2025-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}