Table 2.
Subgroups of LF-LG AS according to AVACT.
| Characteristic | High-gradient severe AS (n = 438) | Classic LF-LG AS (n = 18) | Paradoxical LF-LG AS (n = 55) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| AVACT < 1.2 cm2 | AVACT ≥ 1.2 cm2 | P-value | AVACT < 1.2 cm2 | AVACT ≥ 1.2 cm2 | P-value | AVACT < 1.2 cm2 | AVACT ≥ 1.2 cm2 | P-value | |
| No. of patients (%) | 395 (90.2) | 43 (9.8) | 13 (72.2) | 5 (27.8) | 47 (85.5) | 8 (14.5) | |||
| Age, years | 66.8 ± 8.9 | 67.0 ± 8.4 | 0.92 | 66.1 ± 5.8 | 68.6 ± 7.7 | 0.46 | 67.3 ± 9.2 | 67.3 ± 10.9 | 0.99 |
| Male | 201 (50.9) | 35 (81.4) | < 0.001 | 9 (69.2) | 4 (80.0) | 1.00 | 25 (53.2) | 6 (75.0) | 0.72 |
| BSA, m2 | 1.6 ± 0.2 | 1.7 ± 0.2 | < 0.001 | 1.7 ± 0.2 | 1.6 ± 0.2 | 0.12 | 1.6 ± 0.2 | 1.7 ± 0.1 | 0.34 |
| Hypertension | 208 (52.7) | 23 (53.5) | 1.00 | 7 (53.8) | 5 (100.0) | 0.11 | 26 (55.3) | 4 (50.0) | 1.00 |
| Atrial fibrillation | 59 (14.9) | 6 (14.0) | 1.00 | 3 (23.1) | 1 (20.0) | 1.00 | 2 (4.3) | 2 (25.0) | 0.10 |
| PCI or CABG | 88 (22.3) | 6 (14.0) | 0.29 | 6 (46.2) | 3 (60.0) | 1.00 | 14 (25.5) | 0 (0.0) | 0.10 |
| Rheumatic valvular disease | 37 (9.4) | 1 (2.3) | 0.12 | 2 (15.4) | 0 (0.0) | 1.00 | 6 (12.8) | 2 (25.0) | 0.33 |
| B-type natriuretic peptide, pg/mL | 106.0 (49.0 –282.5) | 51.0 (31.0 –190.5) | 0.05 | 1118.0 (304.8–3066.0) | 738.5 (239.3–3227.5) | 0.80 | 59.0 (32.5–180.5) | 200.5 (59.0–305.3) | 0.38 |
| lnBNP | 4.7 (3.9–5.6) | 3.9 (3.4–5.2) | 0.05 | 7.0 (5.7–8.0) | 6.6 (5.0–7.9) | 0.60 | 4.1 (3.5–5.2) | 5.2 (4.1–5.7) | 0.12 |
| Blood urea nitrogen, mg/dL | 17.7 ± 7.2 | 20.4 ± 10.2 | 0.10 | 25.2 ± 16.7 | 18.6 ± 4.7 | 0.22 | 18.8 ± 8.5 | 18.0 ± 4.7 | 0.81 |
| Creatinine, mg/dL | 0.9 ± 0.6 | 1.4 ± 1.9 | 0.09 | 2.1 ± 2.3 | 1.9 ± 1.3 | 0.76 | 1.0 ± 0.4 | 0.9 ± 0.1 | 0.46 |
| Echocardiography | |||||||||
| LVEF, % | 60.3 ± 10.1 | 60.8 ± 8.9 | 0.72 | 36.9 ± 11.2 | 33.8 ± 8.0 | 0.59 | 62.8 ± 5.4 | 61.5 ± 4.6 | 0.53 |
| Peak velocity, m/s | 5.2 ± 0.7 | 4.9 ± 0.6 | 0.006 | 3.6 ± 0.4 | 3.4 ± 0.7 | 0.37 | 3.5 ± 0.5 | 3.6 ± 0.6 | 0.67 |
| Peak PG, mmHg | 109.8 ± 31.0 | 96.9 ± 22.4 | 0.001 | 53.5 ± 11.7 | 48.0 ± 17.0 | 0.44 | 49.5 ± 16.0 | 53.4 ± 16.9 | 0.53 |
| Mean PG, mmHg | 67.3 ± 19.7 | 58.5 ± 14.7 | 0.001 | 30.8 ± 6.8 | 27.2 ± 10.6 | 0.41 | 27.7 ± 9.4 | 29.8 ± 10.2 | 0.59 |
| LVMI, g/m2 | 135.4 ± 35.8 | 134.8 ± 36.5 | 0.91 | 151.5 ± 33.5 | 144.7 ± 26.3 | 0.69 | 121.5 ± 32.7 | 144.6 ± 50.6 | 0.10 |
| AV VTI, cm | 127.2 ± 25.7 | 101.0 ± 16.5 | < 0.001 | 101.3 ± 34.2 | 78.2 ± 26.9 | 0.20 | 114.2 ± 28.2 | 98.9 ± 21.3 | 0.15 |
| LVOT VTI, cm | 21.3 ± 4.1 | 22.6 ± 3.6 | 0.04 | 16.0 ± 4.8 | 16.2 ± 3.8 | 0.92 | 21.4 ± 3.6 | 19.7 ± 3.7 | 0.24 |
| LVOT diameter, mm | 21.0 ± 1.5 | 21.4 ± 1.5 | 0.10 | 22.1 ± 2.2 | 21.2 ± 0.2 | 0.22 | 21.0 ± 1.4 | 22.2 ± 2.2 | 0.18 |
| LVOT diameter/BSA | 12.9 ± 1.3 | 12.3 ± 1.0 | < 0.001 | 12.9 ± 1.6 | 13.6 ± 1.4 | 0.40 | 13.0 ± 1.4 | 13.2 ± 1.2 | 0.75 |
| AVAecho, mm2 | 59.0 ± 13.6 | 80.4 ± 8.8 | < 0.001 | 61.1 ± 12.8 | 81.9 ± 9.1 | 0.005 | 68.2 ± 13.6 | 77.3 ± 12.7 | 0.08 |
| ESVI | 27.7 ± 16.9 | 28.0 ± 16.4 | 0.92 | 63.0 ± 30.0 | 64.4 ± 20.0 | 0.92 | 23.4 ± 10.6 | 30.7 ± 14.5 | 0.10 |
| EDVI | 66.6 ± 23.4 | 68.7 ± 26.7 | 0.57 | 96.4 ± 32.6 | 95.9 ± 21.3 | 0.98 | 62.0 ± 22.6 | 78.4 ± 31.5 | 0.08 |
| SAC, mL/m2/mmHg | 0.8 ± 0.3 | 0.8 ± 0.3 | 0.11 | 0.7 ± 0.3 | 0.6 ± 0.1 | 0.52 | 0.7 ± 0.3 | 1.0 ± 0.5 | 0.21 |
| Zva, mmHg/mL/m2 | 5.4 ± 1.6 | 5.2 ± 1.7 | 0.51 | 4.7 ± 1.7 | 5.8 ± 2.2 | 0.82 | 4.5 ± 1.4 | 3.8 ± 1.5 | 0.21 |
| CT findings | |||||||||
| Valve morphology | 0.04 | 0.28 | 0.14 | ||||||
| Tricuspid | 177 (44.8) | 27 (62.8) | 9 (69.2) | 5 (100.0) | 26 (55.3) | 2 (25.0) | |||
| Bicuspid | 218 (55.2) | 16 (37.2) | 4 (30.8) | 0 (0.0) | 21 (44.7) | 6 (75.0) | |||
| AVC, Agatston unit | 2834.2 (1605.2–4178.4) | 2426.7 (1616.1–3808.9) | 0.57 | 3912.2 (2247.0–4496.1) | 1360.1 (960.1–2108.6) | 0.002 | 2002.4 (1192.2–2841.6) | 2584.3 (1306.5–5172.0) | 0.12 |
| AVACT | 80.9 ± 18.8 | 136.6 ± 29.6 | < 0.001 | 92.4 ± 15.5 | 122.7 ± 25.2 | 0.007 | 90.2 ± 22.4 | 117.7 ± 27.9 | 0.003 |
| AVAplani, mm2 | 85.2 ± 22.1 | 105.0 ± 26.1 | < 0.001 | 88.2 ± 20.0 | 129.9 ± 5.4 | < 0.001 | 90.1 ± 21.2 | 140.9 ± 13.8 | < 0.001 |
| LVOT area | 346.8 ± 50.0 | 359.6 ± 51.3 | 0.11 | 587.5 ± 129.7 | 572.3 ± 79.9 | 0.81 | 468.9 ± 94.5 | 581.3 ± 94.9 | 0.003 |
| Aortic annulus | |||||||||
| Maximum diameter, mm | 27.1 ± 3.0 | 30.6 ± 3.2 | < 0.001 | 30.6 ± 3.9 | 30.0 ± 2.1 | 0.77 | 27.1 ± 2.6 | 29.0 ± 3.6 | 0.05 |
| Circularity, % | 80.0 ± 1.0 | 80.0 ± 1.0 | 0.22 | 77.6 ± 7.5 | 76.9 ± 4.4 | 0.84 | 82.0 ± 5.7 | 83.8 ± 7.6 | 0.18 |
| Mean diameter, mm | 24.6 ± 2.5 | 27.5 ± 2.6 | < 0.001 | 27.1 ± 2.9 | 26.5 ± 1.4 | 0.70 | 24.7 ± 2.3 | 27.0 ± 3.0 | 0.01 |
| Perimeter, mm | 78.7 ± 8.0 | 87.3 ± 8.6 | < 0.001 | 86.0 ± 8.9 | 83.8 ± 3.7 | 0.46 | 78.7 ± 7.4 | 87.3 ± 10.0 | 0.01 |
| Area, mm2 | 471.4 ± 95.0 | 576.8 ± 119.4 | < 0.001 | 563.3 ± 116.1 | 532.8 ± 45.9 | 0.44 | 475.2 ± 91.3 | 572.9 ± 113.2 | 0.009 |
| Sinus of Valsalva, mm | 36.2 ± 4.5 | 39.4 ± 3.8 | < 0.001 | 39.3 ± 4.9 | 36.1 ± 3.4 | 0.20 | 35.9 ± 4.6 | 42.0 ± 4.2 | 0.001 |
| Sinotubular junction, mm | 30.7 ± 4.6 | 32.8 ± 4.4 | 0.004 | 32.1 ± 3.5 | 30.7 ± 2.8 | 0.44 | 30.6 ± 5.1 | 36.7 ± 7.7 | 0.006 |
| Ascending aorta, mm | 40.7 ± 6.3 | 41.0 ± 5.8 | 0.74 | 39.5 ± 4.4 | 35.5 ± 4.2 | 0.10 | 39.6 ± 7.1 | 45.1 ± 9.8 | 0.06 |
| Normalized to BSA | |||||||||
| AVACT | 51.8 ± 13.0 | 59.7 ± 15.7 | < 0.001 | 53.9 ± 9.4 | 78.3 ± 16.1 | 0.001 | 55.9 ± 14.3 | 70.3 ± 17.9 | 0.01 |
| AVAplani, mm2 | 52.4 ± 13.5 | 60.9 ± 16.4 | < 0.001 | 51.5 ± 12.3 | 82.7 ± 6.0 | < 0.001 | 55.7 ± 12.7 | 84.1 ± 10.4 | < 0.001 |
| LVOT area, mm2 | 294.1 ± 61.4 | 322.3 ± 62.4 | 0.005 | 341.2 ± 69.4 | 365.5 ± 54.6 | 0.50 | 289.3 ± 55.3 | 345.5 ± 54.4 | 0.01 |
| Aortic annulus | |||||||||
| Maximal dimeter, mm | 16.7 ± 1.9 | 17.7 ± 2.0 | 0.002 | 17.9 ± 2.8 | 19.2 ± 2.0 | 0.35 | 16.8 ± 1.7 | 17.4 ± 1.6 | 0.37 |
| Mean diameter, mm | 15.2 ± 1.6 | 15.9 ± 1.6 | 0.006 | 15.8 ± 2.0 | 17.0 ± 1.7 | 0.27 | 15.3 ± 1.6 | 16.1 ± 1.6 | 0.20 |
| Perimeter, mm | 48.5 ± 5.2 | 50.4 ± 5.1 | 0.02 | 50.2 ± 6.0 | 53.6 ± 5.0 | 0.28 | 48.7 ± 4.9 | 52.0 ± 6.8 | 0.10 |
| Area, mm2 | 289.3 ± 53.4 | 331.3 ± 60.0 | < 0.001 | 327.6 ± 65.3 | 339.7 ± 26.4 | 0.70 | 292.7 ± 50.4 | 341.4 ± 71.4 | 0.02 |
| Sinus of Valsalva | 36.2 ± 4.5 | 39.4 ± 3.8 | < 0.001 | 22.9 ± 3.0 | 23.0 ± 2.4 | 0.95 | 22.1 ± 2.6 | 25.1 ± 3.5 | 0.007 |
| Sinotubular junction diameter | 30.7 ± 4.6 | 32.8 ± 4.4 | 0.004 | 18.7 ± 1.9 | 19.6 ± 2.5 | 0.40 | 18.9 ± 2.5 | 21.9 ± 5.3 | 0.01 |
| Ascending aorta tubular portion | 40.7 ± 6.3 | 41.0 ± 5.8 | 0.74 | 23.1 ± 3.0 | 22.6 ± 2.9 | 0.78 | 24.5 ± 4.3 | 26.9 ± 5.7 | 0.18 |
| Surgical valve size, mm | 21.9 ± 2.1 | 23.5 ± 1.8 | < 0.001 | 23.2 ± 2.3 | 22.6 ± 1.7 | 0.63 | 22.1 ± 2.1 | 23.3 ± 1.7 | 0.14 |
| MACCE (cardiovascular death) | 30 (7.6) | 4 (9.3) | 0.92 | 2 (15.4) | 3 (60.0) | 0.10 | 4 (8.5) | 0 (0.0) | 1.00 |
| All-cause mortality | 52 (13.2) | 5 (11.6) | 0.96 | 4 (30.8) | 2 (40.0) | 1.00 | 7 (14.9) | 1 (12.5) | 1.00 |
AS, aortic stenosis; AVA, aortic valve area; AVACT, AVA measured on CT; AVC, aortic valve calcium score; BSA, body surface area; 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; PCI, percutaneous coronary artery intervention; VTI, velocity time integral.