title: 'Paradoxical' low-flow, low-gradient severe aortic valve stenosis: an entity with limited improvement following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The aim of this single-center observational study was to determine the outcome of patients with 'paradoxical' low-flow, low-gradient aortic valve stenosis (PLF-LG-AS) after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Based on pre-procedural echocardiographic data, a total of 150 patients with severe aortic valve stenosis (AS) (indexed aortic valve area (AVA) ≤ 0.6 cm2/m2) who underwent TAVI at the authors' institution were allocated retrospectively to three groups: Group 1: PLF-LG-AS (ejection fraction (EF) ≥ 50%, indexed stroke volume (SV) ≤ 35 ml/m2, mean AV gradient < 40 mmHg; n = 30); Group 2: Classical low-flow, low-gradient AS (CLF-LG-AS: EF < 50%, SV ≤ 35 ml/m2, mean AV gradient < 40 mmHg; n = 21); and Group 3: High-gradient AS (HG-AS: EF < or ≥ 50%, mean AV gradient ≥ 40 mmHg; n = 99).
  
  
  RESULTS
  PLF-LG-AS was associated with an increased relative wall thickness (RWT) and a higher post-procedural systolic blood pressure (sBP) and pulse pressure (PP) (RWT 60.6 ± 15.3%, sBP 144 ± 14 mmHg, PP 79 ± 15 mmHg) compared to patients with HG-AS or CLF-LG-AS: (RWT 52 ± 13% and 40 ± 9%, p < 0.001; sBP 138 ± 15 mmHg and 125 ± 25 mmHg, p = 0.006; PP 68 ± 16 mmHg and 60 ± 21 mmHg, p = 0.01). These patients experienced less improvement in a 6-min walk test (improvement for PLF-LG-AS 14 ± 84 m, for CLF-LG-AS 86 ± 83 m, for HG-AS 87 ± 66 m; intergroup p < 0.007). PLF-LG-AS and CLF-LG-AS were also associated with significantly increased one-year overall mortality (PLF-LG-AS 31%, CLF-LG-AS 19%, HG-AS 6%; p = 0.001) and cardiovascular mortality (PLF-LG-AS 20%, CLF-LG-AS 19%, HG-AS 3%; p = 0.002).
  
  
  CONCLUSIONS
  Patients with PLF-LG-AS may represent a subgroup with a worse clinical outcome after TAVI.
authors: Markus
authors: M
authors: Reinthaler
authors: Anna
authors: A
authors: Schwabe
authors: Ulf
authors: U
authors: Landmesser
authors: Robin
authors: R
authors: Chung
authors: Suneil
authors: S
authors: Aggarwal
authors: Nicola
authors: N
authors: Delahunty
authors: Georg
authors: G
authors: Fröhlich
authors: Pascal
authors: P
authors: Meier
authors: Neil
authors: N
authors: Roberts
authors: Antonis
authors: A
authors: Pantazis
authors: Michael J
authors: MJ
authors: Mullen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001794:Blood Pressure; D002423:Cause of Death; D005080:Exercise Test; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome