{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:03:03Z","timestamp":1790236983085,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Patients with aortic stenosis (AS) may have discordant severity grades between AS by aortic valve area (AS\n                      <jats:sub>AVA<\/jats:sub>\n                      ) and AS using hemodynamic\u2010based guidelines (AS\n                      <jats:sub>GL<\/jats:sub>\n                      ). Individuals with normal left ventricular function and normal\u2010flow low\u2010gradient (NF\u2010LG) AS that is moderate or severe by AVA are downgraded in severity by current guidelines. We evaluated the prevalence and risk of NF\u2010LG AS in patients with moderate or severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We compared the prevalence and mortality of NF\u2010LG AS and low\u2010flow low\u2010gradient (LF\u2010LG) AS compared to normal\u2010flow high\u2010gradient (NF\u2010HG) AS in patients with moderate and severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      and normal left ventricular function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5360 patients, 2974 had moderate AS\n                      <jats:sub>AVA<\/jats:sub>\n                      and 2386 had severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      (mean age 73.3\u00a0\u00b1\u00a012.8 years; 49.3% female; 1637 deaths over median of 4.2 years). In moderate AS\n                      <jats:sub>AVA<\/jats:sub>\n                      , women were more frequently classified as NF\u2010LG AS, with AS severity downgraded to mild using guidelines (52.0% women vs. 29.1% men,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      , women were also more likely to have NF\u2010LG AS and be classified as mild or moderate AS using guidelines (23.9% women vs. 14.4% men,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Patients with NF\u2010LG moderate or severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      had comparable mortality to NF\u2010HG AS (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&gt;\u00a00.05 for each).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Women with moderate or severe AS\n                      <jats:sub>AVA<\/jats:sub>\n                      have markedly higher rates of NF\u2010LG AS than men and are more likely to be assigned a lower AS severity grade based on current guidelines, despite mortality similar to NF\u2010HG AS. Discordance in AS severity between AS\n                      <jats:sub>AVA<\/jats:sub>\n                      and AS\n                      <jats:sub>GL<\/jats:sub>\n                      is common in both genders, although more common in women.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70270","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T15:05:26Z","timestamp":1755615926000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Women With Moderate or Severe Aortic Stenosis by Aortic Valve Area Are Disproportionately Classified With Normal\u2010Flow Low\u2010Gradient Aortic Stenosis and Assigned Lower Severity Grades Than Men"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9302-2643","authenticated-orcid":false,"given":"Christopher","family":"Sidwell","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Curtis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Cleveland Clinic  Cleveland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Kolias","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9674-5212","authenticated-orcid":false,"given":"Troy","family":"LaBounty","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.09.796"},{"key":"e_1_2_9_3_1","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto C. M.","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.02.009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.05.036"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jen303"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2014.03.021"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.033872"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011036"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.9.2262"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.013"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-310729"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2023.06.006"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13144237"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.018816"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahjo.2022.100197"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051200"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70270","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70270","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:37:07Z","timestamp":1772991427000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1111\/echo.70270"],"URL":"https:\/\/doi.org\/10.1111\/echo.70270","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70270"}}