{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:06:21Z","timestamp":1779793581488,"version":"3.53.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The hemodynamic profile and remodeling patterns of paradoxical low\u2010flow, low\u2010gradient aortic stenosis are well understood. However, some patients with severe aortic stenosis exhibit eccentric remodeling with enlarged\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">left ventricular<\/jats:styled-content>\n                      cavities, enabling a normal flow, low ejection fraction (\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">NF<\/jats:styled-content>\n                      \u2010\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">LEF<\/jats:styled-content>\n                      ) phenotype. We assessed the prevalence, hemodynamic characteristics, and post\u2010transcatheter aortic valve implantation outcomes of\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">NF<\/jats:styled-content>\n                      \u2010\n                      <jats:styled-content style=\"fixed-case\" toggle=\"no\">LEF<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this substudy of the COMPARE\u2010TAVI 1 trial, 979 patients undergoing transfemoral transcatheter aortic valve implantation were stratified by left ventricular ejection fraction (LVEF) (&lt; or \u226550%) and stroke volume index (&lt; or \u226535\u2009mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) into 4 groups: normal flow, normal LVEF, NF\u2010LEF, low flow, normal ejection fraction, and low flow, low ejection fraction.\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                      NF\u2010LEF was observed in 10.7% of patients. Reduced LVEF was associated with previous myocardial infarction, pacemakers, New York Heart Association class &gt;2, atrial fibrillation, moderate or worse mitral regurgitation, and larger left ventricular cavities (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) with eccentric hypertrophy (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.004). Compared with low\u2010flow, low\u2010ejection fraction, patients with NF\u2010LEF more frequently had moderate or worse aortic regurgitation (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007), whereas low flow, low ejection fraction showed poorer diastolic indices, suggesting diastolic dysfunction with high left ventricular filling pressures. Patients with low flow, normal ejection fraction were the most symptomatic and showed less improvement in 6\u2010minute walk distance at 1 year compared with normal flow, normal ejection fraction. During follow\u2010up, both low\u2010flow groups demonstrated significant increases in stroke volume index (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), whereas LVEF also improved among patients with reduced LVEF (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">NF\u2010LEF is a prevalent aortic stenosis phenotype characterized by preserved flow despite reduced LVEF, likely driven by eccentric remodeling with moderate or worse aortic regurgitation and more favorable diastolic properties, with similar survival and time\u2010to\u2010event outcomes across phenotypes after transcatheter aortic valve implantation at long\u2010term follow\u2010up. Despite higher comorbidity burdens, patients with NF\u2010LEF showed functional and clinical improvements comparable with normal flow, normal ejection fraction, indicating a severe aortic stenosis phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045521","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T10:47:11Z","timestamp":1765968431000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Paradoxical Normal\u2010Flow Aortic Stenosis Despite Reduced Left Ventricular Ejection Fraction: Insights From the Randomized COMPARE\u2010TAVI 1 Trial"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8992-5493","authenticated-orcid":false,"given":"Emil Johannes","family":"Ravn","sequence":"first","affiliation":[{"name":"Odense University Hospital","place":["Odense, 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Frederiksen","sequence":"additional","affiliation":[{"name":"Aarhus University Hospital","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steen","family":"Hvitfelt Poulsen","sequence":"additional","affiliation":[{"name":"Aarhus University Hospital","place":["Aarhus, Denmark"]},{"name":"Aarhus University Hospital","place":["Aarhus, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":false,"given":"Marie\u2010Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Odense University Hospital","place":["Odense, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0359-8728","authenticated-orcid":false,"given":"Rasmus","family":"Carter\u2010Storch","sequence":"additional","affiliation":[{"name":"Odense University Hospital","place":["Odense, 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