BACKGROUND Clinical features and outcomes in severe aortic stenosis (AS) have been described according to the hemodynamic phenotypes. OBJECTIVES The aim of this study was to investigate the clinical features and prognosis of patients with high-gradient (HG) AS with aortic valve area (AVA) >1.0 cm2. METHODS A total of 3,209 patients were identified according to AVA (cm2), peak velocity (m/s), systolic mean pressure gradient (MG) (mm Hg): HG-AVA >1 = >1.0, ≥4, and ≥40, HG-AVA ≤1 = ≤1.0, ≥4, and ≥40; LG-AVA ≤1 (low-gradient) = ≤1.0, <4, and <40; moderate AS = 1.0 1 accounted for 230 individuals (7.2%). Compared with others, patients with HG-AVA >1 were younger (70.2 ± 12.0 years), more frequently male (85.7%), had fewer comorbidities, larger body surface area and stroke volume (115 ± 19.3 mL), and had higher prevalence of bicuspid valve (39.6%). After a follow-up of 944 days (Q1-Q3: 27-2,212 days), 1,523 deaths occurred. Compared with the HG-AVA >1 group, all-cause mortality was higher in HG-AVA ≤1 (HR: 1.4; 95% CI: 1.1-1.7), LG-AVA ≤1 (HR: 2.8; 95% CI: 2.2-3.6), and moderate AS (HR: 1.4; 95% CI: 1.1-1.7). These differences were no longer significant after adjustment for age, comorbidities, bicuspid valve, and cardiac function. In the HG-AVA >1 group, patients with aortic valve replacement had better survival outcomes than those without aortic valve replacement (P < 0.001) after balancing the 2 groups. CONCLUSIONS The underlying relative high-flow status is responsible for HG in patients with HG-AVA >1. This profile has better prognosis than others, being related to underlying younger age and better general and cardiac conditions, but aortic valve replacement may still benefit these patients.

中文翻译：

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瓣膜面积 >1.0 cm2 的高梯度主动脉瓣狭窄：“被遗忘的”不一致的血流动力学表型。


背景严重主动脉瓣狭窄（AS）的临床特征和结果已根据血流动力学表型进行了描述。目的 本研究的目的是探讨主动脉瓣面积 (AVA) >1.0 cm2 的高梯度 (HG) AS 患者的临床特征和预后。方法 根据 AVA (cm2)、峰值速度 (m/s)、收缩期平均压力梯度 (MG) (mm Hg) 确定 3,209 例患者：HG-AVA >1 = >1.0，≥4，且≥40，HG-AVA≤1=≤1.0，≥4，≥40； LG-AVA ≤1（低梯度）= ≤1.0、<4 和 <40；中度AS = 1.0 1 占230 人（7.2%）。与其他患者相比，HG-AVA >1 患者年龄较小（70.2 ± 12.0 岁），男性较多（85.7%），合并症较少，体表面积和每搏输出量较大（115 ± 19.3 mL），患病率较高二尖瓣 (39.6%)。随访 944 天（第一季度至第三季度：27-2,212 天）后，发生 1,523 例死亡。与 HG-AVA >1 组相比，HG-AVA ≤1（HR：1.4；95% CI：1.1-1.7）、LG-AVA ≤1（HR：2.8；95% CI： 2.2-3.6）和中度 AS（HR：1.4；95% CI：1.1-1.7）。在调整年龄、合并症、二尖瓣和心功能后，这些差异不再显着。在 HG-AVA >1 组中，平衡两组后，接受主动脉瓣置换术的患者比未接受主动脉瓣置换术的患者有更好的生存结果（P < 0.001）。结论 HG-AVA >1 患者出现 HG 的原因是潜在的相对高流量状态。这种情况比其他情况具有更好的预后，与潜在的年轻年龄和更好的一般和心脏状况有关，但主动脉瓣置换术仍然可能使这些患者受益。