{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:05:37Z","timestamp":1767852337852,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Backgrounds<\/jats:title><jats:p>There are limited data on the clinical relevance of transvalvular flow rate (Q<jats:sub>mean<\/jats:sub>) at rest (Q<jats:sub>rest)<\/jats:sub> and at peak stress (Q<jats:sub>stress<\/jats:sub>) during dobutamine stress echocardiography (DSE) in patients with low\u2010gradient severe aortic stenosis (LG\u2010SAS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed the clinical data of patients with LG\u2010SAS who underwent DSE. LG\u2010SAS was defined as an aortic valve (AV) area index of\u00a0&lt;\u00a0.6 cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> and a mean AV pressure gradient (AVPG) of\u00a0&lt;\u00a040\u00a0mm Hg. The primary endpoint included all\u2010cause death and heart failure hospitalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 100 patients (mean age 79.5\u00a0\u00b1\u00a07.3 years; men, 45.0%; resting left ventricular ejection fraction [LVEF] 52.1%\u00a0\u00b1\u00a015.9%; resting stroke volume index 35.8\u00a0\u00b1\u00a07.7\u00a0mL\/m<jats:sup>2<\/jats:sup>; Q<jats:sub>rest<\/jats:sub> 171.8\u00a0\u00b1\u00a034.9\u00a0mL\/s), the primary endpoint occurred in 51 patients during a median follow\u2010up of 2.84 (interquartile range 1.01\u20135.21) years. When the study patients were divided into three subgroups based on Q<jats:sub>rest<\/jats:sub> and Q<jats:sub>stress<\/jats:sub>, the multivariate analysis showed that Qrest\u00a0&lt;\u00a0200\u00a0mL\/s and Qstress \u2265200\u00a0mL\/s (hazard ratio 3.844; 95% confidence interval 1.143\u201312.930; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.030), as well as Q<jats:sub>rest<\/jats:sub> and Qstress\u00a0&lt;\u00a0200\u00a0mL\/s (hazard ratio 9.444; 95% confidence interval 2.420\u201336.850; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.001), were significantly associated with unfavorable outcomes with Q<jats:sub>rest<\/jats:sub> and Qstress \u2265200\u00a0mL\/s as a reference after adjusting for resting LVEF, resting mean AVPG, chronic kidney disease, New York Heart Association functional class III\/IV, and AV replacement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Flow conditions based on the combination of Q<jats:sub>rest<\/jats:sub> and Q<jats:sub>stress<\/jats:sub> are helpful for risk stratification in LG\u2010SAS patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15712","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T08:59:38Z","timestamp":1699433978000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic value of transvalvular flow rate in patients with low\u2010gradient severe aortic stenosis: A dobutamine stress echocardiography study"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6250-3891","authenticated-orcid":false,"given":"Hirokazu","family":"Onishi","sequence":"first","affiliation":[{"name":"Department of Cardiology St. Marianna University School of Medicine  Kanagawa Japan"},{"name":"Department of Cardiology New Tokyo Hospital  Chiba 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