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Updated: Aug 23, 2025

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Published on: February 25, 2022
TAVI for patients with normal-flow low-gradient compared to high-gradient aortic stenosis
Julius Steffen1, David Andreae2, Michael Nabauer2
1Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich.
Normal-flow, low-gradient aortic stenosis (NFLG-AS) patients are not a uniform group. Higher gradient NFLG-AS patients have similar outcomes to high-gradient AS (HG-AS), but lower gradient NFLG-AS patients face increased mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Normal-flow, low-gradient aortic stenosis (NFLG-AS) lacks clear treatment guidelines.
- NFLG-AS is debated due to potential heterogeneity.
- This study investigates NFLG-AS subgroups compared to high-gradient AS (HG-AS).
Purpose of the Study:
- To determine if NFLG-AS patients are heterogeneous.
- To compare clinical characteristics and outcomes of NFLG-AS subgroups with HG-AS.
- To inform treatment recommendations for NFLG-AS.
Main Methods:
- Analysis of 2326 patients undergoing transcatheter aortic valve replacement (TAVI) from 2013-2019.
- Stratification of 386 NFLG-AS patients into higher (n=204) and lower (n=186) gradient groups.
- Comparison of NFLG-AS subgroups with 956 HG-AS patients.
Main Results:
- Higher gradient NFLG-AS patients showed similarities to HG-AS patients in characteristics and outcomes.
- Lower gradient NFLG-AS patients exhibited different characteristics and higher Society of Thoracic Surgeons scores than HG-AS.
- 3-year all-cause mortality was higher in lower gradient NFLG-AS (HR 1.7) but similar in higher gradient NFLG-AS (HR 1.2) compared to HG-AS.
Conclusions:
- NFLG-AS is heterogeneous, with distinct clinical profiles and outcomes.
- Higher gradient NFLG-AS patients appear similar to HG-AS and may not require different treatment strategies.
- Lower gradient NFLG-AS patients have increased long-term mortality, warranting careful consideration for TAVI.
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