title: Prognostic value of paradoxical low-gradient severe aortic stenosis in Japan: Japanese Multicenter Aortic Stenosis Study, Retrospective (JUST-R) Registry.
abstract: BACKGROUND
  Whether the prognosis of paradoxical low-gradient severe aortic stenosis (PLG-SAS), especially due to paradoxical low-flow low-gradient SAS (PLFLG-SAS), is malignant in any specific ethnicity, including Japanese, remains unclear.
  
  
  METHODS
  We retrospectively enrolled 385 consecutive Japanese patients (age, 76±8 years; 148 men) with moderate AS [MAS: 0.6≤indexed aortic valve area (iAVA)<0.85cm(2)/m(2)] or SAS (iAVA <0.6cm(2)/m(2)) with preserved left ventricular ejection fraction (≥50%). SAS patients were divided into PLG-SAS and high-gradient (HG)-SAS according to the transvalvular mean gradient (40mmHg). PLG-SAS was categorized into 2 groups: normal-flow (NF) LG-SAS [stroke volume index (SVi) ≥35mL/m(2)] and PLFLG-SAS (SVi <35mL/m(2)). Endpoints were all-cause death and major adverse cardio-cerebrovascular events (MACE).
  
  
  RESULTS
  During a median follow-up of 15 months, 31 patients died and 48 suffered MACE. All-cause death and MACE rates in PLG-SAS and PLFLG-SAS were significantly lower than those in HG-SAS and similar to those in MAS. On multivariate analysis, neither PLG-SAS nor PLFLG-SAS were independent determinants for all-cause death compared with MAS [MAS as reference, PLG-SAS: hazard ratio (HR) 0.47, p=0.32; PLFLG-SAS: HR 0.01, p=0.20; HG-SAS: HR 3.37, 95% confidence interval 1.24-9.74, p=0.02].
  
  
  CONCLUSIONS
  In Japanese patients, the prognoses of PLG-SAS and PLFLG-SAS were better than that of HG-SAS and similar to that of MAS, being better than that in Western populations.
authors: Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
authors: Eiji
authors: E
authors: Yamashita
authors: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. Electronic address: takeuchi@med.uoeh-u.ac.jp.
authors: Masaaki
authors: M
authors: Takeuchi
authors: Cardiovascular Division, University of Tsukuba, Tsukuba, Japan.
authors: Yoshihiro
authors: Y
authors: Seo
authors: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors: Masaki
authors: M
authors: Izumo
authors: Cardiovascular Division, University of Tsukuba, Tsukuba, Japan.
authors: Tomoko
authors: T
authors: Ishizu
authors: Cardiovascular Division, University of Tsukuba, Tsukuba, Japan.
authors: Kimi
authors: K
authors: Sato
authors: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors: Kengo
authors: K
authors: Suzuki
authors: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors: Yoshihiro J
authors: YJ
authors: Akashi
authors: Cardiovascular Division, University of Tsukuba, Tsukuba, Japan.
authors: Kazutaka
authors: K
authors: Aonuma
authors: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors: Yutaka
authors: Y
authors: Otsuji
authors: Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
authors: Shigeru
authors: S
authors: Oshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Aortic stenosis; Echocardiography; Ethnicity; Low-flow low-gradient; Prognosis