Prognostic value of paradoxical low-gradient severe aortic stenosis in Japan: Japanese Multicenter Aortic Stenosis Study, Retrospective (JUST-R) Registry

BackgroundWhether the prognosis of paradoxical low-gradient severe aortic stenosis (PLG-SAS), especially due to paradoxical low-flow low-gradient SAS (PLFLG-SAS), is malignant in any specific ethnicity, including Japanese, remains unclear.MethodsWe retrospectively enrolled 385 consecutive Japanese patients (age, 76 ± 8 years; 148 men) with moderate AS [MAS: 0.6 ≤ indexed aortic valve area (iAVA) < 0.85 cm2/m2] or SAS (iAVA <0.6 cm2/m2) with preserved left ventricular ejection fraction (≥50%). SAS patients were divided into PLG-SAS and high-gradient (HG)-SAS according to the transvalvular mean gradient (40 mmHg). PLG-SAS was categorized into 2 groups: normal-flow (NF) LG-SAS [stroke volume index (SVi) ≥35 mL/m2] and PLFLG-SAS (SVi <35 mL/m2). Endpoints were all-cause death and major adverse cardio-cerebrovascular events (MACE).ResultsDuring a median follow-up of 15 months, 31 patients died and 48 suffered MACE. All-cause death and MACE rates in PLG-SAS and PLFLG-SAS were significantly lower than those in HG-SAS and similar to those in MAS. On multivariate analysis, neither PLG-SAS nor PLFLG-SAS were independent determinants for all-cause death compared with MAS [MAS as reference, PLG-SAS: hazard ratio (HR) 0.47, p = 0.32; PLFLG-SAS: HR 0.01, p = 0.20; HG-SAS: HR 3.37, 95% confidence interval 1.24–9.74, p = 0.02].ConclusionsIn Japanese patients, the prognoses of PLG-SAS and PLFLG-SAS were better than that of HG-SAS and similar to that of MAS, being better than that in Western populations.