{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T11:26:18Z","timestamp":1763551578658,"version":"3.45.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">In severe mitral stenosis (MS), flow\u2010status was recently recognized as potentially impactful in some patients with low transmitral gradients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We studied 172 patients with isolated rheumatic MS with mitral valve area \u22641.5\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      . Mean gradients &lt;10\u2009mm\u2009Hg and \u226510\u2009mm\u2009Hg were considered low gradient and high gradient, respectively. Similarly, stroke volume index &lt;35\u2009mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      was considered low flow (LF) and \u226535\u2009mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      was considered normal flow (NF). We compared clinical and echocardiographic characteristics including noninvasively determined net atrioventricular compliance, effective arterial elastance, end\u2010systolic elastance, right ventricular function, and a composite outcome of all\u2010cause mortality, heart failure hospitalization, mitral valve intervention, and stroke or transient ischemic attack.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Forty\u2010three (25.0%) patients had NF low\u2010gradient MS, 60 (34.9%) had LF low\u2010gradient MS, 26 (15.1%) had NF high\u2010gradient MS, and 43 (25.0%) had LF high\u2010gradient MS. Patients with LF status were more symptomatic (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008) and had lower atrioventricular compliance (LF 4.37\u00b11.52\u2009mL\/mm\u2009Hg; NF 5.44\u00b11.50\u2009mL\/mm\u2009Hg;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Despite lower left ventricular ejection fraction (LF 51.9\u00b112.1%; NF 61.0\u00b15.3%;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), they had similar end\u2010systolic elastance (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.106) with increased arterial elastance (LF 2.64\u00b10.80\u2009mm\u2009Hg\/mL; NF 1.70\u00b10.44\u2009mm\u2009Hg\/mL;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), and more right ventricular dysfunction (LF 79.6%; NF 36.2%;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Subdividing patients with low flow into LF low\u2010gradient and LF high\u2010gradient subgroups showed similar findings, suggesting that LF status, rather than transmitral gradient, was linked to these findings. LF status was associated with poorer event\u2010free survival (LF, 5.46\u2009years [95% CI, 4.05\u20136.87]; NF, 7.44\u2009years [95% CI, 6.17\u20138.72];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.001) whereas there was no association between mean gradient and outcomes (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.284).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with LF severe MS demonstrated a characteristic pattern of echocardiographic abnormalities and poorer outcomes regardless of transmitral gradients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041884","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:08:48Z","timestamp":1760011728000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics, Hemodynamic Profile, and Outcomes in Patients With Low\u2010Gradient and High\u2010Gradient Severe Mitral Stenosis: Influence of Flow Status"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7730-3144","authenticated-orcid":false,"given":"Ryan","family":"Leow","sequence":"first","affiliation":[{"name":"National University Heart Centre Singapore","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meei\u2010Wah","family":"Chan","sequence":"additional","affiliation":[{"name":"National University Heart Centre 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