{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:40:26Z","timestamp":1791556826062,"version":"4.3.4"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>\n              Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient &lt;40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction &lt;50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction \u226550% but stroke volume index &lt;35 mL\/m\n              <jats:sup>2<\/jats:sup>\n              ) and LG; and normal-flow (left ventricular ejection fraction \u226550% and stroke volume index \u226535 mL\/m\n              <jats:sup>2<\/jats:sup>\n              ) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (\n              <jats:italic>P<\/jats:italic>\n              =0.002) and normal-flow-LG: 32.1% (\n              <jats:italic>P<\/jats:italic>\n              =0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (\n              <jats:italic>P<\/jats:italic>\n              =0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.119.008792","type":"journal-article","created":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T09:00:30Z","timestamp":1594976430000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement"],"prefix":"10.1161","volume":"13","author":[{"given":"Erwan","family":"Salaun","sequence":"first","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca T.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center\/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)."},{"name":"Cardiovascular Research Foundation, New York, NY (R.T.H., Y.Z., M.C.A., M.B.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael A.","family":"Jaber","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, OH (W.A.J., L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico M.","family":"Asch","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute at Washington Hospital Center, DC (F.M.A., N.J.W., V.H.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, OH (W.A.J., L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J.","family":"Weissman","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute at Washington Hospital Center, DC (F.M.A., N.J.W., V.H.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary M.","family":"Gertz","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Virginia Commonwealth University, Richmond (Z.M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard C.","family":"Herrmann","sequence":"additional","affiliation":[{"name":"University of Pennsylvania 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P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oumhani","family":"Toubal","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Bernier","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon","family":"Leipsic","sequence":"additional","affiliation":[{"name":"St Paul\u2019s Hospital, Vancouver, British Columbia, Canada (J.L., P.B., J.G.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Blanke","sequence":"additional","affiliation":[{"name":"St Paul\u2019s Hospital, Vancouver, British Columbia, Canada (J.L., P.B., J.G.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine","family":"Ridard","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec\/Qu\u00e9bec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., 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