{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:48:44Z","timestamp":1790668124555,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"\n Background<\/jats:title>\n \n Optimal management of patients with severe mitral stenosis (\n MS<\/jats:styled-content>\n ) and low transmitral gradient is incompletely understood.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We examined 101 consecutive patients with severe rheumatic\n MS<\/jats:styled-content>\n (mitral valve area \u22641.5\u00a0cm\n 2<\/jats:sup>\n ) who underwent balloon valvuloplasty. Low gradient was defined as mean transmitral gradient <10\u00a0mm\u00a0Hg and low flow as stroke volume index \u226435\u00a0mL\/m\n 2<\/jats:sup>\n by echocardiography. Symptoms and mortality data were collected. Systolic, diastolic, and arterial function were characterized by measuring left ventricular (LV) end\u2010systolic elastance,\n LV<\/jats:styled-content>\n stiffness constant (\u03b2), diastolic capacitance (predicted LV end\u2010diastolic volume at a common LV filling pressure of 30\u00a0mm\u00a0Hg), and effective arterial elastance. Low gradient (<10\u00a0mm\u00a0Hg) was present in 55 patients, including low flow\/low gradient in 11 and normal flow\/low gradient in 44 patients, and high gradient was present in 46 patients. Participants with low\u2010flow\/low\u2010gradient (LG)\n MS<\/jats:styled-content>\n were older with higher rates of atrial fibrillation (64%) and subvalvular thickening, higher afterload, and decreased\n LV<\/jats:styled-content>\n compliance with lower ejection fraction (57\u00b110% versus 65\u00b14% versus 63\u00b16%,\n P<\/jats:italic>\n =0.002) but similar end\u2010systolic elastance compared with patients with normal\u2010flow\/\n LG<\/jats:styled-content>\n and high\u2010gradient\n MS<\/jats:styled-content>\n . The normal\u2010flow\/\n LG<\/jats:styled-content>\n group had larger mitral valve area and lower left atrial pressure by catheterization, as well as favorable long\u2010term outcomes compared with the low\u2010flow\/\n LG<\/jats:styled-content>\n and high\u2010gradient\n MS<\/jats:styled-content>\n group. A total of 40% of patients with\n LG MS<\/jats:styled-content>\n had no symptomatic benefit from valvuloplasty compared with 18% of patients with high\u2010gradient\n MS<\/jats:styled-content>\n (\n P<\/jats:italic>\n =0.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Presence of low gradient in patients with severe\n MS<\/jats:styled-content>\n was associated with lesser symptomatic benefit from valvuloplasty. In the subset with low stroke volume index, this may be related to independent ventricular\u2010vascular uncoupling, decreased\n LV<\/jats:styled-content>\n compliance, and high prevalence of atrial fibrillation in addition to intrinsic\n MS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010736","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T10:05:04Z","timestamp":1550829904000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Low\u2010Gradient Severe Mitral Stenosis: Hemodynamic Profiles, Clinical Characteristics, and Outcomes"],"prefix":"10.1161","volume":"8","author":[{"given":"Abdallah","family":"El Sabbagh","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh N. V.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Barros\u2010Gomes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin V.","family":"Pislaru","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick A.","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.029"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02487-7"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000031"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.52.5.894"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.12.1.69"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.21.1.117"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.67.1.148"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2006.09.006"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/nprot.2007.270"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01651-5"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2007.10.001"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.2.513"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.003695"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.24.4.712"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(62)90171-6"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(61)90150-3"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(96)90248-3"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90246-J"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.003071"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000164"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/12.suppl_B.66"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.11.4.531"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.42.6.1099"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.35.5.497"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.64.5.609"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00429.2011"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.163"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(60)90455-5"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(99)00915-7"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00153-2"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy126"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(89)90599-8"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.010736","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:54:14Z","timestamp":1715597654000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.010736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,5]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,3,5]]}},"alternative-id":["10.1161\/JAHA.118.010736"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.010736","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,5]]},"assertion":[{"value":"2018-09-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e010736"}}