{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:04:46Z","timestamp":1776229486666,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Australian Government RTP"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Although an association between the systemic circulation and transaortic flow rate (TFR) is frequently hypothesized in patients with aortic stenosis (AS), it has not been demonstrated previously. We sought to explore the relationship between blood pressure (BP), vascular afterload measures, clinical history of hypertension, TFR, and survival in patients with severe AS (aortic valve area \u2264 1\u2005cm\u00b2).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We studied 323 patients \u2265 65 years (110 prospective, 213 registry analysis) who underwent transcatheter aortic valve replacement over a 5-year period. Aortic flow was obtained by Doppler echocardiography, with TFR calculated using a mathematical derivation method. A BP \u2265 140\/90\u2005mmHg and\/or mean arterial pressure \u2265 90\u2005mmHg was considered hypertensive. Simultaneous pressure\u2013flow analysis demonstrated that higher systolic BP (\u00df \u22120.545; P = 0.01\u2020), pulse pressure (\u00df \u22120.545; P = 0.01\u2020), vascular resistance (\u00df \u22120.02; P = 0.041), characteristic impedance (\u00df \u22120.27; P = 0.01), and lower arterial compliance (\u00df 32.73; P &amp;lt; 0.001\u2020) were associated with reduced TFR in linear regression. In registry analysis, TFR was lower in those with a history of hypertension (223 \u00b1 67 vs. 244 \u00b1 77\u2005mL\/s; r \u22120.138; P = 0.045), coronary artery disease (CAD, P &amp;lt; 0.01), dialysis dependency (P &amp;lt; 0.01), and with increased anti-hypertensive medication use (P = 0.04), of which CAD (\u00df \u221228.5; P = 0.08\u2020) and dialysis dependency (\u00df \u221268.5; P = 0.04\u2020) remained significant in linear regression. A TFR \u2264 210\u2005mL\/s in normotensive patients was the strongest predictor of mortality (73.3% vs. 86.7%; P = 0.043; \u2020 denotes adjusted).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Elevated vascular afterload measures and comorbidities linked to arteriosclerosis and\/or degenerative aortic stiffening independently reduce flow rates in severe AS. A TFR \u2264 210\u2005mL\/s predicts mortality but improves with BP assessment during evaluation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeae331","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T14:24:41Z","timestamp":1737642281000},"page":"674-685","source":"Crossref","is-referenced-by-count":10,"title":["The effect of increased vascular afterload measures on flow rate and survival in severe aortic stenosis"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0040-7719","authenticated-orcid":false,"given":"Sara L","family":"Hungerford","sequence":"first","affiliation":[{"name":"The CardioVascular Center, Tufts Medical Center , 800 Washington Street, Boston, MA 02111 ,","place":["USA"]},{"name":"Faculty of Health and Medicine, The University of Sydney , Science Rd, Camperdown, NSW 2050 ,","place":["Australia"]},{"name":"Department of Cardiology, Royal North Shore Hospital , Reserve Rd, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Song","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medicine, Wallace Wurth Building (C27) , Cnr High St & Botany St, UNSW Sydney, Kensington, NSW 2033 ,","place":["Australia"]},{"name":"Department of Cardiology, St Vincent's Hospital , 390 Victoria St, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Victor Chang Cardiac Research Institute , Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Loo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Vincent's Hospital , 390 Victoria St, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hari","family":"Sritharan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal North Shore Hospital , Reserve Rd, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor","family":"Rye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal North Shore Hospital , Reserve Rd, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kay","family":"Everett","sequence":"additional","affiliation":[{"name":"The CardioVascular Center, Tufts Medical Center , 800 Washington Street, Boston, MA 02111 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Vincent's Hospital , 390 Victoria St, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Victor Chang Cardiac Research Institute , Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-1890","authenticated-orcid":false,"given":"Christopher","family":"Hayward","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medicine, Wallace Wurth Building (C27) , Cnr High St & Botany St, UNSW Sydney, Kensington, NSW 2033 ,","place":["Australia"]},{"name":"Department of Cardiology, St Vincent's Hospital , 390 Victoria St, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Victor Chang Cardiac Research Institute , Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navin K","family":"Kapur","sequence":"additional","affiliation":[{"name":"The CardioVascular Center, Tufts Medical Center , 800 Washington Street, Boston, MA 02111 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W 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