{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:37:20Z","timestamp":1786120640325,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"30","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The conventional paradigm in aortic stenosis (AS) holds that progressive valvular obstruction increases afterload, leading to left ventricular remodelling and dysfunction. However, emerging artificial intelligence (AI)-based observational data challenge this sequence. Diastolic dysfunction risk scores, generated without valve imaging, predict future AS even in individuals with aortic sclerosis. This paradox suggests that diastolic dysfunction is not simply a downstream effect but a barometer of a shared upstream pathophysiological state. In this hypothesis, diastolic dysfunction identifies a mechano-inflammatory milieu marked by arterial stiffness, elevated afterload, and disrupted ventriculo-valvular-vascular coupling, which distorts aortic flow and shear stress. This environment promotes structural and functional remodelling in both the myocardium and the aortic valve via shared signalling pathways\u2014yet is more readily detected in the myocardium. By linking AI-based phenotyping with biomechanics and inflammation, this hypothesis challenges current causal hierarchies and proposes a new framework for early risk assessment in calcific AS.<\/jats:p>","DOI":"10.1093\/eurheartj\/ehag435","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:44:19Z","timestamp":1778845459000},"page":"4100-4104","source":"Crossref","is-referenced-by-count":1,"title":["Diastolic dysfunction is linked to the initiation and progression of aortic stenosis: a hypothesis"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2291-5001","authenticated-orcid":false,"given":"Partho P","family":"Sengupta","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4454-4240","authenticated-orcid":false,"given":"Naveena","family":"Yanamala","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ ,","place":["USA"]},{"name":"Software and Societal Systems Department, School of Computer Science, Carnegie Mellon University , Pittsburgh, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillipe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Department of Medicine, Qu\u00e9bec Heart and Lung Institute, Laval University , Qu\u00e9bec City, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"2026080619570152500_ehag435-B1","doi-asserted-by":"publisher","first-page":"2885","DOI":"10.1093\/eurheartj\/ehab153","article-title":"Electrocardiogram screening for aortic valve stenosis using artificial intelligence","volume":"42","author":"Cohen-Shelly","year":"2021","journal-title":"Eur Heart J"},{"key":"2026080619570152500_ehag435-B2","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jcmg.2024.07.017","article-title":"Deep learning model of diastolic dysfunction risk stratifies the progression of early-stage aortic stenosis","volume":"18","author":"Tokodi","year":"2025","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026080619570152500_ehag435-B3","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1001\/jamacardio.2024.0595","article-title":"A multimodal video-based AI biomarker for aortic stenosis development and progression","volume":"9","author":"Oikonomou","year":"2024","journal-title":"JAMA Cardiol"},{"key":"2026080619570152500_ehag435-B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2021.100801","article-title":"Left ventricular remodeling in degenerative aortic valve stenosis","volume":"46","author":"Abecasis","year":"2021","journal-title":"Curr Probl Cardiol"},{"key":"2026080619570152500_ehag435-B5","unstructured":"Sengupta PP . 2026. AI and the unexpected link with aortic stenosis occurrence and progression. 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