Table 1.
Clinical and imaging characteristics of high-gradient severe, classic LF-LG, paradoxical LF-LG AS groups (n = 511).
| Characteristic | High-gradient severe AS | Classic LF-LG AS | Paradoxical LF-LG AS | P-value |
|---|---|---|---|---|
| No. of patients (%) | 438 (85.7) | 18 (3.5) | 55 (10.8) | |
| Age, years | 66.8 ± 8.8 | 66.8 ± 6.2 | 67.3 ± 9.4 | 0.93 |
| Male | 236 (53.9) | 13 (72.2) | 31 (56.4) | 0.30 |
| BSA, m2 | 1.6 ± 0.2 | 1.7 ± 0.2 | 1.6 ± 0.2 | 0.56 |
| Hypertension | 231 (52.7) | 12 (66.7) | 30 (54.5) | 0.50 |
| Atrial fibrillation | 65 (14.8) | 4 (22.2) | 4 (7.3) | 0.20 |
| PCI or CABG | 94 (21.5) | 9 (50.0)* | 14 (25.5) | 0.02 |
| BNP, pg/mL | 99.5 (43.0–280.5) | 944.5 (304.8–3066.0)* | 70.0 (35.0–190.0) | < 0.001 |
| lnBNP | 4.6 (3.8–5.6) | 6.8 (5.7–8.0)* | 4.2 (3.6–5.2) | < 0.001 |
| Echocardiography | ||||
| LVEF, % | 60.3 ± 10.0 | 36.0 ± 10.3* | 62.6 ± 5.3 | < 0.001 |
| Peak velocity, m/s | 5.2 ± 0.7 | 3.6 ± 0.5* | 3.5 ± 0.5† | < 0.001 |
| Peak PG, mmHg | 108.5 ± 30.5 | 52.0 ± 13.1* | 50.1 ± 16.0† | < 0.001 |
| Mean PG, mmHg | 66.5 ± 19.4 | 29.8 ± 7.9* | 28.0 ± 9.5† | < 0.001 |
| LVMI, g/m2 | 135.4 ± 35.8 | 149.6 ± 31.1 | 124.9 ± 36.2 | 0.03 |
| AV VTI, cm | 124.6 ± 26.1 | 94.9 ± 33.3* | 112.0 ± 27.7† | < 0.001 |
| LVOT VTI, cm | 21.4 ± 4.1 | 16.0 ± 4.4* | 21.2 ± 3.7 | < 0.001 |
| LVOT diameter, mm | 21.0 ± 1.5 | 21.8 ± 1.9 | 21.2 ± 1.6 | 0.06 |
| LVOT diameter/BSA | 12.9 ± 1.3 | 13.1 ± 1.6 | 13.0 ± 1.3 | 0.55 |
| AVAecho, mm2 | 61.3 ± 14.7 | 66.9 ± 15.1 | 69.5 ± 13.8† | < 0.001 |
| ESVI, mL/m2 | 27.7 ± 16.8 | 63.4 ± 27.0* | 24.5 ± 11.4 | < 0.001 |
| EDVI, mL/m2 | 66.8 ± 23.7 | 96.3 ± 29.3* | 64.3 ± 24.5 | < 0.001 |
| SAC, mL/m2/mmHg | 0.8 ± 0.3 | 0.7 ± 0.3 | 0.8 ± 0.3 | 0.28 |
| Zva, mmHg/mL/m2 | 5.3 ± 1.6 | 5.0 ± 1.9 | 4.4 ± 1.4† | < 0.001 |
| CT findings | ||||
| Valve morphology | 0.04 | |||
| Tricuspid | 204 (46.6) | 14 (77.8) | 28 (50.9) | |
| Bicuspid with raphe | 106 (24.2) | 3 (16.7) | 17 (30.9) | |
| Bicuspid without raphe | 128 (29.2) | 1 (5.6) | 10 (18.2) | |
| AVC, Agatston unit | 3027.2 ± 1872.0 | 2895.5 ± 1624.5 | 2363.1 ± 1605.8† | 0.04 |
| AVCratio‡ | 1.8 ± 1.0 | 1.6 ± 0.8 | 1.4 ± 0.8† | 0.006 |
| LVOT mean diameter | 24.8 ± 2.9 | 27.1 ± 2.7* | 24.7 ± 2.6 | 0.003 |
| AVACT, mm2 | 84.9 ± 23.4 | 100.8 ± 22.7* | 94.2 ± 25.0† | 0.001 |
| AVAplani, mm2 | 87.2 ± 23.2 | 99.7 ± 25.5* | 97.5 ± 27.1† | 0.003 |
| Aortic annulus | ||||
| Circularity, % | 81.6 ± 7.6 | 77.4 ± 6.6 | 82.3 ± 6.0 | 0.05 |
| Maximal dimeter, mm | 27.5 ± 3.2 | 30.4 ± 3.5* | 27.4 ± 2.8 | 0.001 |
| Mean diameter, mm | 24.9 ± 2.6 | 26.9 ± 2.5* | 25.0 ± 2.6 | 0.005 |
| Perimeter, mm | 79.5 ± 8.4 | 85.4 ± 7.7* | 80.0 ± 8.3 | 0.02 |
| Area, mm2 | 481.8 ± 102.4 | 554.8 ± 101.0* | 489.5 ± 99.9 | 0.01 |
| Sinus of Valsalva, mm | 36.6 ± 4.5 | 38.4 ± 4.7 | 36.8 ± 5.0 | 0.25 |
| Sinotubular junction, mm | 30.9 ± 4.6 | 31.7 ± 3.3 | 31.5 ± 5.9 | 0.58 |
| Ascending aorta tubular portion, mm | 40.7 ± 6.3 | 38.4 ± 4.6 | 40.4 ± 7.7 | 0.31 |
| Normalized to BSA | ||||
| AVACT, mm2 | 51.7 ± 13.6 | 60.7 ± 15.8* | 58.0 ± 15.6† | < 0.001 |
| AVAplani, mm2 | 52.6 ± 13.5 | 59.5 ± 17.5* | 57.8 ± 15.2† | 0.005 |
| Aortic annulus | ||||
| Maximal dimeter, mm | 16.8 ± 2.0 | 18.2 ± 2.6* | 16.9 ± 1.7 | 0.01 |
| Mean diameter, mm | 15.2 ± 1.6 | 16.1 ± 1.9 | 15.4 ± 1.6 | 0.06 |
| Perimeter, mm | 48.7 ± 5.2 | 51.1 ± 5.8 | 49.2 ± 5.3 | 0.12 |
| Area, mm2 | 293.4 ± 55.5 | 331.0 ± 56.6* | 299.7 ± 55.9 | 0.02 |
| Sinus of Valsalva, mm | 22.4 ± 2.9 | 23.0 ± 2.8 | 22.6 ± 2.9 | 0.65 |
| Sinotubular junction diameter, mm | 18.9 ± 2.9 | 18.9 ± 2.1 | 19.3 ± 3.2 | 0.69 |
| Ascending aorta tubular portion, mm | 25.0 ± 4.3 | 23.0 ± 2.9 | 24.8 ± 4.6 | 0.15 |
| Surgical valve size, mm | 22.1 ± 2.1 | 23.0 ± 2.1 | 22.3 ± 2.0 | 0.18 |
| Surgical valve type | N/A | |||
| CE Magna | 144 | 10 | 18 | |
| ATSAP | 82 | 4 | 8 | |
| Hancock | 82 | 1 | 13 | |
| St. Jude Regent | 80 | 3 | 11 | |
| Others | 50 | 0 | 5 | |
| Operator | 0.47 | |||
| Operator 1 | 170 | 5 | 18 | |
| Operator 2 | 95 | 2 | 12 | |
| Operator 3 | 81 | 4 | 15 | |
| Operator 4 | 64 | 4 | 7 | |
| Operator 5 | 28 | 3 | 3 | |
| MACCE | 34 (7.8) | 5 (27.8)* | 4 (7.3) | 0.01 |
| All-cause mortality | 57 (13.0) | 6 (33.3) | 8 (14.5) | 0.05 |
| Follow-up duration, d | 1517.5 (1188.8–2026.5) | 1134.0 (26.0–1682.0) | 1455.0 (1112.0–1944.0) | 0.007 |
Values are means ± standard deviations or numbers and percentages in parentheses.
*Significant difference between patients with high-gradient severe aortic stenosis and patients with classic LF-LG AS groups.
†Significant difference between high-gradient severe aortic stenosis and paradoxical LF-LG AS groups.
‡Value divided by sex-specific thresholds (Male, 2000; Female, 1250).
AS aortic stenosis, AV aortic valve, AVA aortic valve area, AVC aortic valve calcium score, BNP B-type natriuretic peptide, CABG coronary artery bypass graft, EDVI end-diastolic volume index, ESVI end-systolic volume index, LF-LG low-flow and low-gradient, lnBNP log-transformed B-type natriuretic peptide, LVEF left ventricular ejection fraction, LVMI left ventricular mass index, LVOT left ventricular outflow tract, MACCE major adverse cardiac and cerebrovascular event, N/A not available, PCI percutaneous coronary artery intervention, PG pressure gradient, SAC systemic arterial compliance, VTI velocity time integral, Zva valvulo-arterial impedance.