{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:20:01Z","timestamp":1789510801110,"version":"build-2803163510"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The prevalence and outcomes of the different subtypes of severe low\u2010gradient aortic stenosis (AS) in routine clinical cardiology practice have not been well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Data were derived from the National Echocardiography Database of Australia. Of 192\u00a0060 adults (aged 62.8\u00b117.8\u00a0[mean\u00b1SD] years) with native aortic valve profiling between 2000 and 2019, 12\u00a0013 (6.3%) had severe AS. Of these, 5601 patients (47%) had high\u2010gradient and 6412 patients (53%) had low\u2010gradient severe AS. The stroke volume index was documented in 2741 (42.7%) patients with low gradient; 1750 patients (64%) with low flow, low gradient (LFLG); and 991 patients with normal flow, low gradient. Of the patients with LFLG, 1570 (89.7%) had left ventricular ejection fraction recorded; 959 (61%) had paradoxical LFLG (preserved left ventricular ejection fraction), and 611 (39%) had classical LFLG (reduced left ventricular ejection fraction). All\u2010cause and cardiovascular\u2010related mortality were assessed in the 8162 patients with classifiable severe AS subtype during a mean\u00b1SD follow\u2010up of 88\u00b145\u00a0months. Actual 1\u2010year and 5\u2010year all\u2010cause mortality rates varied across these groups and were 15.8% and 49.2% among patients with high\u2010gradient severe AS, 11.6% and 53.6% in patients with normal\u2010flow, low\u2010gradient severe AS, 16.9% and 58.8% in patients with paradoxical LFLG severe AS, and 30.5% and 72.9% in patients with classical LFLG severe AS. Compared with patients with high\u2010gradient severe AS, the 5\u2010year age\u2010adjusted and sex\u2010adjusted mortality risk hazard ratios were 0.94 (95% CI, 0.85\u20131.03) in patients with normal\u2010flow, low\u2010gradient severe AS; 1.01 (95% CI, 0.92\u20131.12) in patients with paradoxical LFLG severe AS; and 1.65 (95% CI, 1.48\u20131.84) in patients with classical LFLG severe AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Approximately half of those patients with echocardiographic features of severe AS in routine clinical practice have low\u2010gradient hemodynamics, which is associated with long\u2010term mortality comparable with or worse than high\u2010gradient severe AS. The poorest survival was associated with classical LFLG severe AS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.021126","type":"journal-article","created":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T08:38:38Z","timestamp":1635583118000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Prevalence and Outcomes of Low\u2010Gradient Severe Aortic Stenosis\u2014From the National Echo Database of Australia"],"prefix":"10.1161","volume":"10","author":[{"given":"Afik D.","family":"Snir","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health University of Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin K.","family":"Ng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health University of Sydney Australia"},{"name":"Department of Cardiology Royal Prince Alfred Hospital Camperdown Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-7119","authenticated-orcid":false,"given":"Geoff","family":"Strange","sequence":"additional","affiliation":[{"name":"Heart Research Institute Newtown Australia"},{"name":"School of Medicine University of Notre Dame Fremantle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4492-1103","authenticated-orcid":false,"given":"David","family":"Playford","sequence":"additional","affiliation":[{"name":"School of Medicine University of Notre Dame Fremantle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9032-8998","authenticated-orcid":false,"given":"Simon","family":"Stewart","sequence":"additional","affiliation":[{"name":"Torrens University Australia Adelaide Australia"},{"name":"University of Glasgow Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7640-0439","authenticated-orcid":false,"given":"David S.","family":"Celermajer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health University of Sydney Australia"},{"name":"Department of Cardiology Royal Prince Alfred Hospital Camperdown Australia"},{"name":"Heart Research Institute Newtown Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60211-7"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw096"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.004"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307528"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.076"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.07.001"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2020.04.024"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2003.tb00615.x"},{"key":"e_1_3_1_11_2","volume-title":"ICD\u201010: International Statistical Classification of Diseases and Related Health Problems\/World Health Organization","author":"World Health Organization","year":"2004","unstructured":"World Health Organization . 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National Library of Medicine. May 30 2021. Available at: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01835028."},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.181982"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.09.026"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.001"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000031"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.006"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.06.002"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.021126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:17:32Z","timestamp":1715584652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.021126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":31,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2021,11,16]]}},"alternative-id":["10.1161\/JAHA.121.021126"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.021126","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]},"assertion":[{"value":"2021-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e021126"}}