ArticleOpen heart2021
Discordant severity criteria in patients with moderate aortic stenosis: prognostic implications.
Article in Open heart, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 12 citations in OpenAlex.
- Prognosis in asymptomatic patients with discordantly graded aortic valve stenosis based on pressure recovery adjusted valve area.Open heart · 2022Trial
- Discordant High-Gradient Aortic Stenosis: A Systematic Review.Journal of cardiovascular development and disease · 2025Review
- Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis.Journal of the American Heart Association · 2024Article
- Integrating Echocardiographic Findings to Improve Diagnostic and Prognostic Assessments in Moderate Aortic Valve Stenosis: A Comprehensive Review.The journal of Tehran Heart Center · 2024Review
- Machine learning prediction of progressive subclinical myocardial dysfunction in moderate aortic stenosis.Frontiers in cardiovascular medicine · 2023Article
- Discordant moderate aortic stenosis: is it clinically important?Open heart · 2021Article
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Authors and funding
13 authors at 7 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe criteria to define the grade of aortic stenosis (AS)-aortic valve area (AVA) and mean gradient (MG) or peak jet velocity-do not always coincide into one grade. Although in severe AS, this discrepancy is well characterised, in moderate AS, the phenomenon of discordant grading has not been investigated and its prognostic implications are unknown.
objectivesTo investigate the occurrence of discordant grading in patients with moderate AS (defined by an AVA between 1.0 cm² and 1.5 cm² but with an MG <20 mm Hg) and how these patients compare with those with concordant grading moderate AS (AVA between 1.0 cm² and 1.5 cm² and MG ≥20 mm Hg) in terms of clinical outcomes.
methodsFrom an ongoing registry of patients with AS, patients with moderate AS based on AVA were selected and classified into discordant or concordant grading (MG <20 mm Hg or ≥20 mm Hg, respectively). The clinical endpoint was all-cause mortality.
resultsOf 790 patients with moderate AS, 150 (19.0%) had discordant grading, moderate AS. Patients with discordant grading were older, had higher prevalence of previous myocardial infarction and left ventricular (LV) hypertrophy, larger LV end-diastolic and end-systolic volume index, higher LV filling pressure and lower LV ejection fraction and stroke volume index as compared with their counterparts. After a median follow-up of 4.9 years (IQR 3.0-8.2), patients with discordant grading had lower aortic valve replacement rates (26.7% vs 44.1%, p<0.001) and higher mortality rates (60.0% vs 43.1%, p<0.001) as compared with patients with concordant grading. Discordant grading moderate AS, combined with low LV ejection fraction, presented the higher risk of mortality (HR 2.78 (2.00-3.87), p<0.001).
conclusionDiscordant-grading moderate AS is not uncommon and, when combined with low LV ejection fraction, is associated with high risk of mortality.
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