{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:05:52Z","timestamp":1790420752291,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity \u22654 m\/s or mean gradient \u226540 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              One thousand five hundred forty-one patients with aortic valve area \u22641 cm\n              <jats:sup>2<\/jats:sup>\n              and left ventricular ejection fraction \u226550% were identified and classified as high-gradient AS (HGAS) (\u226540 mm\u2009Hg) and LGAS (&lt;40 mm\u2009Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Mean age was 76\u00b111 years, female 47%. Mean gradient was 51\u00b112 in SR-HGAS, 48\u00b110 in AF-HGAS, 31\u00b15 in SR-LGAS, and 29\u00b17 mm\u2009Hg in AF-LGAS, all\n              <jats:italic>P<\/jats:italic>\n              \u22640.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581\u20133462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978\u20134229,\n              <jats:italic>P<\/jats:italic>\n              =0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817\u20132810,\n              <jats:italic>P<\/jats:italic>\n              =0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945\u20131832,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001); AVCS in AF-LGAS were higher when HS were present (\n              <jats:italic>P<\/jats:italic>\n              =0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40\u20132.36],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04\u20132.26],\n              <jats:italic>P<\/jats:italic>\n              =0.03) but not different in AF-LGAS without HS or SR-LGAS (both\n              <jats:italic>P<\/jats:italic>\n              =not significant).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.120.012453","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T09:00:10Z","timestamp":1626080410000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation"],"prefix":"10.1161","volume":"14","author":[{"given":"Said","family":"Alsidawi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."},{"name":"Minneapolis Heart Institute, Minneapolis, MN (S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."},{"name":"University of Minnesota, Minneapolis, MN (S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin V.","family":"Pislaru","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy J.","family":"Thaden","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"El-Am","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."},{"name":"Department of Medicine, Indiana University School of Medicine, Indianapolis (E.A.E.-A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1340-0647","authenticated-orcid":true,"given":"Christopher G.","family":"Scott","sequence":"additional","affiliation":[{"name":"Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (C.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem","family":"Morant","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."},{"name":"North York General Hospital, Toronto, ON, Canada (K.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4818-0170","authenticated-orcid":true,"given":"Didem","family":"Oguz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9821-1225","authenticated-orcid":true,"given":"Sushil A.","family":"Luis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., S.K., S.V.P., J.J.T., E.A.E.-A., K.M., D.O., S.A.L., R.P., C.E.L., R.B.M., P.A.P., J.K.O., V.T.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratnasari","family":"Padang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.A., 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