{
  "abstract": "Background In low-gradient severe aortic stenosis (AS), reduced left ventricular ejection fraction (LVEF <50%) is practically used to define low flow and prompt dobutamine stress echocardiography to discern pseudo-severe AS. In patients with preserved LVEF, stroke volume index (SVI) <35 mL/m² is typically used. However, both are volume-based surrogates. Transaortic flow rate (TAFR), calculated as stroke volume divided by left ventricular ejection time, may better reflect true flow. Nonetheless, comparative data between TAFR and established metrics remain limited. We aimed to evaluate the prognostic value of TAFR in symptomatic low-gradient severe AS.Methods We retrospectively identified patients with low-gradient severe AS (AVA ≤1 cm 2 and peak velocity (Vmax) <4 m/s or mean gradient (MG) <40 mm Hg) who underwent transcatheter aortic valve replacement at Mayo Clinic sites (2017–2023). The primary outcome was 1-year all-cause mortality. Survival was assessed using Kaplan-Meier and Cox proportional hazards models.Results Among 475 patients included (mean age 85±8 years; 49% women), 242 (51%) had TAFR <220 mL/s, 165 (35%) had EF <50%, and 221 (47%) had SVI <35 mL/m 2. Low TAFR was significantly associated with higher 1-year mortality even after stratifying by EF or SVI. In multivariate analysis, TAFR was an independent predictor of mortality (HR 2.38; 95% CI 1.19 to 4.76, p=0.014) after adjusting for reduced LVEF, low SVI, gender, chronic kidney disease and mitral and tricuspid regurgitation.Conclusions In patients with symptomatic low-gradient severe AS, low TAFR, not SVI or LVEF, is independently associated with mortality and may offer more accurate measure of flow state for clinical staging.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Mohamed Allam"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Cecilia Villa Etchegoyen"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Said Alsidawi"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Girish Pathangey"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Hesham Sheashaa"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Nikita Rafie"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Ramzi Ibrahim"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Juan M Farina"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Ahmed K Mahmoud"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Kamal Awad"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Mahmoud Abdelnabi"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Kristen Sell-Dottin"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Steven J Lester"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "John P Sweeney"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Chadi Ayoub"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Kwan Lee"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "David F Fortuin"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Reza Arsanjani"
    }
  ],
  "title": "Prognostic value of transaortic flow rate compared with ejection fraction and stroke volume index in low-gradient severe aortic stenosis",
  "uid": "49a98d65-afe9-5211-bf83-e0ffc0c3fc99"
}