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 .

中文翻译：

---

中度主动脉瓣狭窄患者严重程度标准不一致：预后影响

背景 定义主动脉瓣狭窄 (AS) 等级的标准——主动脉瓣面积 (AVA) 和平均梯度 (MG) 或峰值射流速度——并不总是一致为一个等级。虽然在严重的 AS 中，这种差异是很好的表征，但在中度的 AS 中，尚未研究分级不一致的现象，其预后意义尚不清楚。目的 调查中度 AS（定义为 AVA 介于 1.0 cm² 和 1.5 cm² 但MG <20 mm Hg）患者中不一致分级的发生情况，以及这些患者与分级一致的中度 AS（AVA 介于 1.0 cm² 之间）的情况和 1.5 cm² 和 MG ≥20 mm Hg）在临床结果方面。方法 从正在进行的 AS 患者登记中，选择基于 AVA 的中度 AS 患者，并将其分为不一致或一致的分级（MG < 20 毫米汞柱或≥20 毫米汞柱）。临床终点是全因死亡率。结果 790 例中度 AS 患者中，150 例 (19.0%) 分级不一致，为中度 AS。分级不一致的患者年龄较大，既往心肌梗死和左心室（LV）肥厚的患病率较高，LV 舒张末期和收缩末期容积指数较大，LV 充盈压较高，LV 射血分数和每搏输出量指数较低。他们的同行。中位随访 4.9 年（IQR 3.0-8.2）后，分级不一致的患者主动脉瓣置换率较低（26.7% 对 44.1%，p<0.001）和死亡率较高（60.0% 对 43.1%，p< 0.001) 与具有一致分级的患者相比。中度 AS 分级不一致，结合低 LV 射血分数，表示更高的死亡风险（HR 2.78 (2.00–3.87)，p<0.001）。结论不一致分级的中度 AS 并不少见，当与低 LV 射血分数相结合时，与高死亡风险相关。当前手稿中提供的数据可应合理要求提供。数据不在存储库中，由未识别身份的参与者数据组成，可根据合理要求在.