Hungerford, Sara L. and Song, Ning and Loo, Brandon and Rye, Eleanor and Sritharan, Hari and Everett, Kay D. and Hayward, Christopher S. and Kapur, Navin K. and Muller, David W.M. and Adji, Audrey I. (2026) The Effect of Volume-Flow Discordance on Survival in Severe Aortic Stenosis. JACC: Asia, 6 (1). pp.66-76. ISSN 27723747
Full text not available from this repository.Abstract
BACKGROUND: Current flow (Q) assessment in aortic stenosis (AS) uses stroke volume index (SVi), a volume (V)-based measure. However, V differs fundamentally from Q, which is defined as volume per unit time (mL/s). OBJECTIVES: This study evaluates the prognostic significance of volume-flow (V-Q) discordance in patients with severe AS (aortic valve area <1 cm(2)) undergoing transcatheter aortic valve replacement (TAVR). METHODS: We studied 291 patients >65 years of age who underwent TAVR over 5 years (median follow-up, 3.0 years; [Q1-Q3: 3.0-3.0 years]). Aortic flow was assessed using Doppler echocardiography; transaortic flow rate (TFR) was calculated mathematically. Low V-Q discordance was defined as SVi <35 mL/m(2) with TFR >210 mL/s; normal V-Q discordance as SVi >35 mL/m(2) with TFR <210 mL/s. RESULTS: V-Q discordance was observed in 29% of patients (15% low, 14% normal). Among those with SVi <35 mL/m(2), discordance was more frequent in patients without hypertension (75% vs 65%), coronary disease (57% vs 35%), or diabetes (15% vs 2%; all P < 0.05). Diastolic blood pressure was lower (mean SD: 66+15 vs 59+14 mm Hg; P = 0.018), and arterial compliance was higher (median and Q1-Q3: 1.3 [1.1-1.6] vs 1.0 [0.9-1.2] mL/mm Hg; P = 0.028), independent of SVi and left ventricular ejection fraction (both P > 0.05). Low V-Q discordance was associated with improved 3-year survival (86.0% [95% CI: 72.3%-95.1%] vs 73.8% [95% CI: 64.3%-82.1%]; log-rank P = 0.030) and was a stronger survival predictor (Akaike information criterion [AIC]: 23.79; P = 0.013) than SVi <35 mL/m(2) (AIC: 29.59; P = 0.047) or TFR <210 mL/s (AIC: 32.80; P = 0.049). CONCLUSIONS: V-Q discordance occurs in nearly one-third of patients with AS post-TAVR and offers superior prognostic value over existing SVi and TFR thresholds.
| Item Type: | Article |
|---|---|
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 29 Aug 2026 05:11 |
| Last Modified: | 29 Aug 2026 05:11 |
| URI: | http://eprints.victorchang.edu.au/id/eprint/1822 |
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