Conversion from low pressure gradient to high pressure gradient is an ominous prognostic sign in patients with paradoxical low flow low pressure gradient severe aortic stenosis

Purpose: Controversy exists regarding prognosis in Paradoxical Low Flow Low Pressure Gradient (PLFLPG) severe Aortic Stenosis (AS) despite normal Left Ventricular Ejection Fraction (LVEF). Little is known about conversion rate from low Pressure Gradient (PG) to high PG during longitudinal study and its impact on prognosis. Methods: Among 220 patients with severe PLFLPG AS (indexed aortic valve area< 0.6cm2/m2, mean PG< 40mmHg) and preserved LVEF (>50%), we selected 86 patients who had received more than 2 echo examinations at least 6 months apart. Patients were followed up, and Cardiac Death (CD) and Major Cardiovascular Events (MACEs), including CD, aortic valve replacement, non-fatal myocardial infarction and congestive heart failure were determined. Results: During a follow up for a median of 720 days from the first echo study, 2 patients died due to CD, and 14 patients developed MACEs. After a mean of 419 days from the first to the second echo examinations, 67 patients (78%) still remained low PG status and other 19 patients (22%) converted from low PG to high PG AS. Although no significant difference of CD was noted between the two groups, MACE was significantly higher in high PG group compared to low PG group. MACE-free survival of HPG/LPG group Conclusions: Overall, prognosis in Japanese patients with PLFLPG severe AS seems to be better compared to Western patients. However, conversion from low PG to high PG status occurred in 1/4 of patients during follow up, and this was associated with poorer prognosis.