TY - JOUR T1 - Discordant severity criteria in patients with moderate aortic stenosis: prognostic implications JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2021-001639 VL - 8 IS - 1 SP - e001639 AU - Stephan M Pio AU - Mohammed R Amanullah AU - Steele C Butcher AU - Kenny Y Sin AU - Nina Ajmone Marsan AU - Philippe Pibarot AU - Nicolas M Van Mieghem AU - Zee Pin Ding AU - Philippe Généreux AU - Martin B Leon AU - See Hooi Ewe AU - Victoria Delgado AU - Jeroen J Bax Y1 - 2021/06/01 UR - http://openheart.bmj.com/content/8/1/e001639.abstract N2 - Background The 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.Objectives To 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.Methods From 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.Results Of 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).Conclusion Discordant-grading moderate AS is not uncommon and, when combined with low LV ejection fraction, is associated with high risk of mortality.The data presented in the current manuscript are available upon reasonable request. The data are not in a repository and consist of deidentified participant data which can be available upon reasonable request at https://orcid.org/0000-0002-9841-2737. ER -