Paradoxical low-flow low-gradient severe aortic stenosis had higher mortality (32.4% vs 15.9%, p=0.049) despite similar intervention rates at 1 year.
Does paradoxical low-flow low-gradient pattern increase mortality compared to high gradient pattern in patients with severe aortic stenosis?
Paradoxical low-flow low-gradient severe aortic stenosis is associated with higher mortality than high-gradient severe AS, suggesting that intervention should not be delayed in these patients.
Abstract Background Severe aortic stenosis (AS) may be presented with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has an specific clinical profile but prognosis and management remains controversial. Purpose Our aim is to evaluate impact of different AS patterns in major clinical events appearance. Methods A retrospective observational study was carried out on all the consecutive patients diagnosed with severe AS at our tertiary hospital centre during 2021. Echocardiographic measurements were carefully reviewed and patients were classified following current guidelines into four categories: high gradient (HG), concordant low-flow low-gradient (CLF-LG), paradoxical low-flow low-gradient (PLF-LG), and normal-flow low-gradient (NF-LG). Baseline characteristics and clinical events (heart failure admission, intervention and death) at 1 year follow-up were collected from medical records. Association between categories and events was established with Student t test or ANOVA as required. Results 205 patients with severe AS were included in the study (81±10 years old, 52.7% female). Category distribution was as follows: HG (138, 67,3%), PLF-LG (34, 19,8%), CLF-LG (21, 10,2%), NF-LG (12, 5,9%). During the follow-up 24.8% were admitted due to heart failure, 68,3% got valve replacement (51,7% TAVR), and 22% died. Severe tricuspid regurgitation was more frequent in PLF-LG than in HG AS (14.7% vs 2.2%; p0.01). Despite no differences in intervention rate, more patients with PLF-LG (32.4% vs 15.9%; p = 0.049) died during the evolution. Conclusions PLF-LG pattern was the second most common pattern of severe AS in our cohort and it was related to a higher mortality with no differences in intervention rate. Thus, the intervention in this entity should not be delayed.
Osinalde et al. (2025) studied this question. Paradoxical low-flow low-gradient severe aortic stenosis had higher mortality (32.4% vs 15.9%, p=0.049) despite similar intervention rates at 1 year.