Conflicting prognostic results have been reported in patients with discordant high-gradient aortic stenosis ([DHG-AS] the combination of a mean pressure gradient ≥40 mm Hg and an aortic valve area [AVA] >1 cm). Moreover, existing studies only included selected patients without concomitant aortic regurgitation. The authors assessed the prevalence and survival of patients presenting with DHG-AS in an unselected group of consecutive patients presenting to the echocardiography laboratory of a tertiary referral center. A total of 3,547 adult patients with AVA ≤1.5 cm and peak aortic jet velocity ≥2.5 m/s or mean gradient ≥25 mm Hg who presented between 2005 and 2015 were included. Baseline clinical and echocardiographic data, and, when available, aortic valve calcium (AVC) score were collected in an institutional database, with subsequent retrospective analysis. The primary endpoint was all-cause mortality during follow-up. DHG-AS was observed in 163 patients (11.6% of patients with a high gradient). After adjustment for potential confounders, overall mortality rate of patients with DHG-AS was similar to that of patients with concordant severe aortic stenosis (HR: 0.98 [95% CI: 0.66-1.44]; = 0.91), and patients with discordant low-gradient aortic stenosis (HR: 0.85 [95% CI: 0.58-1.26]; = 0.42), and higher than concordant moderate aortic stenosis (HR: 0.54 [95% CI: 0.36-0.81]; = 0.003). After adjustment for aortic velocities, aortic regurgitation had no significant impact on survival. AVC was higher than in patients with concordant moderate aortic stenosis and discordant low-gradient aortic stenosis, and not significantly different from that of concordant severe aortic stenosis. DHG-AS is not uncommon. Whereas AVA >1.0 cm is often seen as moderate aortic stenosis, a high-pressure gradient conveys a poor prognosis, whatever the AVA and the severity of concomitant aortic regurgitation.

中文翻译：

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不一致的高梯度主动脉瓣狭窄患者的患病率和结果

据报道，在不一致的高梯度主动脉瓣狭窄（[DHG-AS]平均压力梯度≥40 mm Hg和主动脉瓣面积[AVA]>1 cm的组合）患者中，预后结果相互矛盾。此外，现有研究仅纳入不伴有主动脉瓣反流的选定患者。作者评估了在三级转诊中心超声心动图实验室就诊的一组未经选择的连续患者中出现 DHG-AS 的患者的患病率和生存率。共有 3,547 名 2005 年至 2015 年间就诊的 AVA ≤1.5 cm、主动脉射流峰值速度≥2.5 m/s 或平均梯度≥25 mm Hg 的成年患者纳入研究。基线临床和超声心动图数据以及主动脉瓣钙（AVC）评分（如果有）被收集到机构数据库中，并进行随后的回顾性分析。主要终点是随访期间的全因死亡率。在 163 名患者中观察到 DHG-AS（11.6% 的患者具有高梯度）。调整潜在混杂因素后，DHG-AS 患者的总体死亡率与患有一致严重主动脉瓣狭窄的患者相似（HR：0.98 [95% CI：0.66-1.44]；= 0.91），以及患有不一致的低主动脉瓣狭窄的患者。梯度主动脉瓣狭窄（HR：0.85 [95% CI：0.58-1.26]；= 0.42），并且高于一致的中度主动脉瓣狭窄（HR：0.54 [95% CI：0.36-0.81]；= 0.003）。调整主动脉速度后，主动脉瓣关闭不全对生存没有显着影响。 AVC 高于一致的中度主动脉瓣狭窄和不一致的低梯度主动脉瓣狭窄的患者，并且与一致的重度主动脉瓣狭窄患者没有显着差异。 DHG-AS 并不罕见。虽然 AVA >1.0 cm 通常被视为中度主动脉瓣狭窄，但无论 AVA 和伴随主动脉瓣反流的严重程度如何，高压梯度都会导致预后不良。