Key result
Discordant high-gradient AS carries similar 10-year mortality to concordant stenosis, while AVR improves survival.
Why the study?
Data on clinical outcomes in patients with discordant high-gradient aortic stenosis remain conflicting, and limited information exists regarding the impact of aortic valve replacement in this population.
Does aortic valve replacement improve survival in patients with discordant high-gradient aortic stenosis, and how do their outcomes compare to concordant high-gradient aortic stenosis?
Cohort (n=14,640)
Does aortic valve replacement improve survival in patients with discordant high-gradient aortic stenosis, and how do their outcomes compare to concordant high-gradient aortic stenosis?
Hazard Ratio: 1.07 (95% CI 0.92–1.25)
Aortic valve replacement is associated with significantly improved 10-year survival in patients with discordant high-gradient aortic stenosis, yielding survival rates comparable to those with concordant high-gradient aortic stenosis.
BACKGROUND: Data on clinical outcomes in patients with discordant high-gradient aortic stenosis (DHG-AS), defined by elevated gradients despite an aortic valve area (AVA) >1 cm², remain conflicting. Limited information exists regarding the impact of aortic valve replacement (AVR) in DHG-AS. METHODS: We analyzed patients with high-gradient aortic stenosis (mean gradient ≥40 mmHg), categorized as concordant (AVA indexed to body surface area [AVAi] ≤0.6 cm²/m²) or discordant (AVAi >0.6 cm²/m²). Propensity score matching (PSM) (1:1) adjusted for demographics and comorbidities. Kaplan-Meier curves and Cox proportional hazards models compared mortality and AVR rates between concordant high-gradient aortic stenosis (CHG-AS) and DHG-AS. For AVR, competing-risk methods used death as a competing event. In a subgroup of DHG-AS patients after PSM, Cox regression with AVR as a time-dependent covariate evaluated its association with mortality. RESULTS: A total of 14,640 patients were included (13,678 CHG-AS; 962 DHG-AS). After PSM, 958 patients were in each group. DHG-AS had lower AVR rates (subdistribution HR [SHR] 0.56; 95% CI 0.50-0.63; Gray p<0.001). Ten-year mortality was higher in DHG-AS in univariable analysis (HR 1.24; 95% CI 1.07-1.44; p=0.005), but not after adjusting for AVR (HR 1.07; 95% CI 0.92-1.25). In DHG-AS patients after PSM (n=360 per group), AVR reduced 10-year mortality (HR 0.538; 95% CI 0.418-0.692). CONCLUSIONS: After accounting for AVR, survival did not differ significantly between DHG-AS and CHG-AS. AVR was associated with improved survival in DHG-AS, supporting timely intervention.
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Sheashaa et al. (2026) conducted a cohort in High-gradient aortic stenosis (n=14,640). Discordant high-gradient aortic stenosis (DHG-AS) vs. Concordant high-gradient aortic stenosis (CHG-AS) was evaluated on 10-year mortality (adjusted for AVR) (HR 1.07, 95% CI 0.92-1.25). Discordant high-gradient aortic stenosis had similar 10-year mortality to concordant stenosis after adjusting for AVR (HR 1.07; 95% CI 0.92-1.25), while AVR significantly improved survival in DHG-AS.
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