{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:52:15Z","timestamp":1791618735603,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow\/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) &amp;lt; 40 mmHg and left ventricular ejection fraction (LVEF) &amp;lt; 50%]; paradoxical LFLG [MG &amp;lt; 40\u2005mmHg, LVEF \u2265 50%, and stroke volume index (SVi) &amp;lt; 35\u2005ml\/m2]; and normal-flow low-gradient (MG &amp;lt; 40\u2005mmHg, LVEF \u2265 50%, and SVi \u2265 35\u2005ml\/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02\u20132.20]; P = 0.04 for mortality; HR = 1.45 [1.01\u20132.09]; P &amp;lt; 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07\u20132.49]; P = 0.02 for mortality; HR = 1.54 [1.02\u20132.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01\u20135.11]; P &amp;lt; 0.05 and composite outcome, HR = 3.00 [1.16\u20137.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeac089","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T16:56:43Z","timestamp":1653497803000},"page":"46-58","source":"Crossref","is-referenced-by-count":23,"title":["Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7235-5551","authenticated-orcid":false,"given":"Miho","family":"Fukui","sequence":"first","affiliation":[{"name":"Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation , 920 E 28th Street, Suite 100, 55407 Minneapolis, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed-Salah","family":"Annabi","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec , Quebec, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitor E E","family":"Rosa","sequence":"additional","affiliation":[{"name":"Heart Institute of Sao Paulo (InCor), University of Sao Paulo , Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrique B","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Heart Institute of Sao Paulo (InCor), University of Sao Paulo , Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa I","family":"Stanberry","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation , 920 E 28th Street, Suite 100, 55407 Minneapolis, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":false,"given":"Marie-Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec , Quebec, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-7095","authenticated-orcid":false,"given":"Josep","family":"Rod\u00e9s-Cabau","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec , Quebec, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Tarasoutchi","sequence":"additional","affiliation":[{"name":"Heart Institute of Sao Paulo (InCor), University of Sao Paulo , Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B","family":"Schelbert","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Bergler-Klein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna General Hospital , Vienna , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp E","family":"Bartko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna 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