{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:59:40Z","timestamp":1789991980356,"version":"4.0.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>\n              Up to 30% of patients with severe aortic stenosis (SAS; indexed aortic valve area &lt;0.6 cm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              ) present with low transvalvular gradient despite a normal left ventricular ejection fraction. Presently, there is intense controversy as to the prognostic implications of such findings. Accordingly, the aim of the present work was to compare the natural history of patients with paradoxical low-gradient (PLG) or high-gradient (HG) SAS.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We prospectively studied 349 patients with SAS and preserved left ventricular ejection fraction. Patients were categorized into HG-SAS (n=144) and PLG-SAS (n=205) according to mean transvalvular gradient (mean gradient &gt;40 or \u226440 mm Hg). Primary end points were all-cause mortality and echocardiographic disease progression. To evaluate natural history, patients undergoing aortic valve replacement were censored at the time of surgery (n=92). During a median follow-up of 28 months, 148 patients died. Kaplan\u2013Meier survival curves showed better survival in PLG-SAS than in HG-SAS, both in the overall population (48% versus 31%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and in the asymptomatic subgroup (59% versus 35%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.02). In asymptomatic patients, Cox analysis identified age, diabetes mellitus, left atrial volume, and mean gradient as independent predictors of death. Finally, at last echocardiographic follow-up, PLG-SAS demonstrated significant increases in mean gradient (from 29\u00b16 to 38\u00b111 mm Hg;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Our study indicates that PLG-SAS is a less malignant form of AS compared with HG-SAS, because their spontaneous outcome is better. We further demonstrated that patients with PLG-SAS are en route toward the more severe HG-SAS form, because the majority of them evolve into HG-SAS over time.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.113.001695","type":"journal-article","created":{"date-parts":[[2014,4,29]],"date-time":"2014-04-29T06:17:38Z","timestamp":1398752258000},"page":"714-722","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":84,"title":["Natural History of Paradoxical Low-Gradient Severe Aortic Stenosis"],"prefix":"10.1161","volume":"7","author":[{"given":"Fr\u00e9d\u00e9ric","family":"Maes","sequence":"first","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamila","family":"Boulif","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Pi\u00e9rard","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"de Meester","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Melchior","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Gerber","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Vancraeynest","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Catherine","family":"Pouleur","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siham","family":"Lazam","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agn\u00e8s","family":"Pasquet","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"Vanoverschelde","sequence":"additional","affiliation":[{"name":"From P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique, Universit\u00e9 Catholique de Louvain, Brussels, Belgium, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.983510"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm543"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.181982"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.16.1940"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.668681"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp361"},{"key":"e_1_3_3_8_2","first-page":"81","article-title":"Severe isolated aortic stenosis with normal left ventricular systolic function and low transvalvular gradients: pathophysiologic and prognostic insights.","volume":"17","author":"Barasch E","year":"2008","unstructured":"Barasch E, Fan D, Chukwu EO, Han J, Passick M, Petillo F, Norales A, Reichek N. Severe isolated aortic stenosis with normal left ventricular systolic function and low transvalvular gradients: pathophysiologic and prognostic insights. J Heart Valve Dis. 2008;17:81\u201388.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht094"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.111.967554"},{"key":"e_1_3_3_11_2","first-page":"1179","article-title":"Recommendations for chamber quantification.","volume":"21","author":"Lang RM","year":"2008","unstructured":"Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W; American Society of Echocardiography\u2019s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. J Am Soc Echocardiogr. 2008;21:1179\u20131201.","journal-title":"J Am Soc Echocardiogr"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.054"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.08.072"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.113.003695"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2003.12.002"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.894170"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.045203"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.038497"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.05.021"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm095"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.001094"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.112.000031"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.001290"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(51)90002-6"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-008-9362-9"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.05.018"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.01.391"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-302881"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.113.000515"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.08.1621"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.113.001695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:21:59Z","timestamp":1715566919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.113.001695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,7]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,7]]}},"alternative-id":["10.1161\/CIRCIMAGING.113.001695"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.113.001695","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7]]},"assertion":[{"value":"2013-11-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-04-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-04-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}