{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T23:57:53Z","timestamp":1783814273931,"version":"3.55.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To assess the progression of the disease and evolution of the main echocardiographic variables for quantifying AS in patients with severe low-flow low-gradient (LFLG) AS compared to other severe AS subtypes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Longitudinal, observational, multicenter study including consecutive asymptomatic patients with severe AS (aortic valve area, AVA &amp;lt; 1.0 cm\u00b2) and normal left ventricle ejection fraction (LVEF \u2265 50%). Patients were classified according to baseline echocardiography into: HG (high gradient; mean gradient \u2265 40 mmHg), NFLG (normal-flow low-gradient; mean gradient &amp;lt; 40 mmHg, indexed systolic volume (SVi) &amp;gt; 35mL\/m2), or LFLG (mean gradient &amp;lt; 40 mmHg, SVi \u2264 35 mL\/m\u00b2). AS progression was analyzed by comparing patients\u2019 baseline measurements and their last follow-up measurements or those taken prior to aortic valve replacement (AVR). Of the 903 included patients, 401 (44.4%) were HG, 405 (44.9%) NFLG, and 97 (10.7%) LFLG. Progression of the mean gradient in a linear mixed regression model was greater in low-gradient groups: LFLG vs. HG (regression coefficient 0.124, P = 0.005) and NFLG vs. HG (regression coefficient 0.068, P = 0.018). No differences were observed between the LFLG and NFLG groups (regression coefficient 0.056, P = 0.195). However, AVA reduction was slower in the LFLG group compared to the NFLG (P &amp;lt; 0.001). During follow-up, in conservatively-managed patients, 19.1% (n = 9) of LFLG patients evolved to having NFLG AS and 44.7% (n = 21) to having HG AS. In patients undergoing AVR, 58.0% (n = 29) of LFLG baseline patients received AVR with a HG AS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with a HG AS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jead067","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T05:11:36Z","timestamp":1683090696000},"page":"1120-1128","source":"Crossref","is-referenced-by-count":4,"title":["Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6828-5928","authenticated-orcid":false,"given":"Laura","family":"Galian-Gay","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u00b4Hebron-VIHR, Universitat Aut\u00f2noma de Barcelona , Barcelona , Spain"},{"name":"CIBER cardiovascular (CIBERCV) , 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