{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:43:21Z","timestamp":1793094201564,"version":"4.5.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"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":[[2024,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>In patients with severe aortic stenosis (AS), low-flow low-gradient (LG) is a known predictor of worse outcomes. However, very LG may represent a distinct population with further cardiac dysfunction. It is unknown whether this population benefits from transcatheter aortic valve replacement (TAVR). We aimed to describe the patient characteristics and clinical outcomes of low-flow very LG severe AS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This single-centre study included all patients with low-flow severe AS between 2019 and 2021. Patients were divided into groups with very LG [mean pressure gradient (MPG) \u2264 20 mmHg], LG (20 &amp;lt; MPG &amp;lt; 40 mmHg), and high-gradient (HG) (MPG \u2265 40 mmHg). Composite endpoint of all-cause mortality and heart failure rehospitalization was compared. A total of 662 patients [very LG 130 (20%); LG 339 (51%); HG 193 (29%)] were included. Median follow-up was 12 months. Very LG cohort had a higher prevalence of comorbid conditions with lower left ventricular ejection fraction (45% vs. 57% vs. 60%; P &amp;lt; 0.001). There was a graded increase in the risk of composite endpoint in the lower MPG strata (P &amp;lt; 0.001). Among those who underwent TAVR, very LG was an independent predictor of the composite endpoint (adjusted HR 2.42 [1.29\u20134.55]). While LG and HG cohorts had decreased risk of composite endpoint after TAVR compared with conservative management, very LG was not associated with risk reduction (adjusted HR 0.69 [0.35\u20131.34]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Low-flow very LG severe AS represents a distinct population with significant comorbidities and worse outcomes. Further studies are needed to evaluate the short- and long-term benefits of TAVR in this population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jead243","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T21:23:43Z","timestamp":1695849823000},"page":"267-277","source":"Crossref","is-referenced-by-count":9,"title":["Transcatheter aortic valve replacement outcomes in patients with low-flow very low-gradient aortic stenosis"],"prefix":"10.1093","volume":"25","author":[{"given":"Hiroki A","family":"Ueyama","sequence":"first","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. Levy Place, New York, NY 10029 , USA"},{"name":"Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel , NY , USA"},{"name":"Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshay","family":"Chopra","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. Levy Place, New York, NY 10029 , USA"},{"name":"Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur","family":"Dalsania","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. Levy Place , New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Romana","family":"Prandi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. Levy Place, New York, NY 10029 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1888-0793","authenticated-orcid":false,"given":"Samin K","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. Levy Place, New York, NY 10029 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annapoorna","family":"Kini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , One Gustave L. 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