{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:38:47Z","timestamp":1790419127307,"version":"4.1.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,8,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>\n                      The optimal management of low-gradient \u201csevere\u201d aortic stenosis (mean gradient &lt;40 mm Hg, indexed aortic valve area \u22640.6 cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ) with preserved left ventricular ejection fraction remains controversial because gradients may be similar after aortic valve replacement (AVR). We compared outcomes of low-gradient severe aortic stenosis with AVR or medical therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Comprehensive echocardiographic measurements including hemodynamic calculations were completed in 260 prospectively identified patients with symptomatic low-gradient severe aortic stenosis. Patients were followed up for mortality over 28\u00b124 months. AVR was performed in 123 patients (47%). Compared with AVR patients, medically treated patients had a higher prevalence of diabetes mellitus (25% versus 41%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.009), lower stroke volume index (36.4\u00b18.4 versus 34.4\u00b18.7 mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>P<\/jats:italic>\n                      =0.02), higher pulmonary artery pressure (38\u00b111 versus 48\u00b121 mm Hg,\n                      <jats:italic>P<\/jats:italic>\n                      =0.001), and higher creatinine level (1.1\u00b10.4 versus 1.22\u00b10.5 mg\/dL,\n                      <jats:italic>P<\/jats:italic>\n                      =0.02). These and other clinically relevant variables were entered into a propensity model that reflected likelihood of referral to AVR. This score and other variables were entered into a Cox model to explore the independent effect of AVR on outcome. During follow-up, 105 patients died (40%): 32 (30%) in the AVR group and 73 (70%) in the medical treatment group. AVR (hazard ratio, 0.54; 95% confidence interval, 0.32\u20130.94;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) was independently associated with outcome and remained a strong predictor of survival after adjustment for propensity score. Medical therapy was associated with 2-fold greater all-cause mortality than AVR. The protective effect of AVR was similar in 125 patients with normal flow (stroke volume index &gt;35 mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>P<\/jats:italic>\n                      =0.22).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>AVR is associated with better survival than medical therapy in patients with symptomatic low-gradient severe AS and preserved left ventricular ejection fraction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.112.001094","type":"journal-article","created":{"date-parts":[[2013,6,29]],"date-time":"2013-06-29T03:45:55Z","timestamp":1372477555000},"page":"622-631","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":129,"title":["Impact of Aortic Valve Replacement on Outcome of Symptomatic Patients With Severe Aortic Stenosis With Low Gradient and Preserved Left Ventricular Ejection Fraction"],"prefix":"10.1161","volume":"128","author":[{"given":"Alper","family":"Ozkan","sequence":"first","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, and Menzies Research Institute Tasmania, Hobart, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory","family":"Hachamovitch","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, and Menzies Research Institute Tasmania, Hobart, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, and Menzies Research Institute Tasmania, Hobart, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Murat","family":"Tuzcu","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, and Menzies Research Institute Tasmania, Hobart, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Marwick","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, and Menzies Research Institute Tasmania, Hobart, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"e_1_3_3_3_2","first-page":"e84","article-title":"ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.","volume":"114","author":"American College of Cardiology\/American Heart Association Task Force on Practice Guidelines, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons","year":"2006","unstructured":"American College of Cardiology\/American Heart Association Task Force on Practice Guidelines, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Thoracic SurgeonsBonow RO, Carabello BA, Kanu C, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O\u2019Gara PT, O\u2019Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. 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