ArticleCirculation. Cardiovascular imaging2025
Severe Mitral Regurgitation in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis.
Shani Dahan, Jacob P Dal-Bianco, Ygal Plakht, Mayooran Namasivayam, Romain Capoulade, Xin Zeng, Jonathan Passeri, Evin Yucel, Michael H Picard, Robert A Levine and 1 more
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In one paragraphArticle in Circulation. Cardiovascular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 · Who and what moneyAuthors and funding
11 authors.
Shani DahanDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0003-4536-9701 Jacob P Dal-BiancoDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).
Ygal PlakhtDepartment of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Y.P.).ORCID 0000-0003-0898-9776 Romain CapouladeDepartment of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (R.C.).ORCID 0000-0002-7233-7409 Xin ZengDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).
Jonathan PasseriDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0003-2465-2460 Evin YucelDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0002-7074-6380 Michael H PicardDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0002-9264-3243 Robert A LevineDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0002-9484-8218 Judy HungDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., J.P.D.-B., X.Z., J.P., E.Y., M.H.P., R.A.L., J.H.).ORCID 0000-0003-3737-7584 Funding
REVISED CAROL ACT IIU01HL088942 · NHLBI · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI GELIJNS, ANNE CHRISTINE, MOSKOWITZ, ALAN J · 2007 to 2025
$122.6MMechanism of Myocardial Fibrosis Induced by Mitral Valve ProlapseR01HL173930 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI JUDY W HUNG, Serguei MELNITCHOUK · 2024 to 2026
$5.4MPolymer Therapy for Ischemic Mitral RegurgitationR01HL092101 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HUNG, JUDY W · 2009 to 2013
$2.1MNHLBI NIH HHS R01 HL092101NHLBI NIH HHS R01 HL173930NHLBI NIH HHS U01 HL088942
6 · The paper itselfAbstract
backgroundPatients with paradoxical low-flow, low-gradient severe aortic stenosis exhibit low transvalvular flow rate (Q), while maintaining preserved left ventricular ejection fraction. Severe mitral regurgitation (MR) also causes a low-flow state, adding complexity to diagnosis and management. This study aimed to examine the impact of severe MR on outcomes in paradoxical low-flow, low-gradient severe aortic stenosis.
methodsData from an institutional echo database identified 1189 patients with adjudicated severe aortic stenosis (aortic valve area ≤1.0 cm
resultsIn the severe MR group (n=80), patients had lower flow rates, increased left ventricular dimensions, and a more eccentric hypertrophy pattern compared with non-severe MR (n=1109). Over a follow-up of up to 5 years, severe MR correlated with higher all-cause mortality (
conclusionsSevere MR in paradoxical low-flow, low-gradient severe aortic stenosis is associated with adverse outcomes and distinctive left ventricular remodeling. Aortic valve replacement improves survival across all MR grades, with greater impact in severe MR.
Indexed as
Aortic ValveAortic Valve StenosisMitral ValveMitral Valve InsufficiencyVentricular Function, LeftAgedAged, 80 and overFemaleHeart Valve Prosthesis ImplantationHumansMaleRetrospective StudiesRisk FactorsSeverity of Illness IndexStroke Volumeaortic valve stenosisheart failuremitral valve insufficiencystroke volumeventricular function, left
Identifiers
PMID40116009
PMCPMC12245404
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