Clinical, echocardiographic and prognostic outcomes of patients with concordant and discordant high-gradient aortic stenosis in an Asian cohort.

Literature of patients with severe high-gradient aortic stenosis (HG AS) (mean pressure gradient [MPG] ≥ 40 mmHg and aortic valve area [AVA] ≥ 1.0 cm 2 ) remains limited. This study seeks to compare the prognostic outcomes of patients with high-gradient concordant (HG CON- AS) and discordant AS (HG DIS- AS) in an Asian cohort. From 2010 to 2015, patients with moderate-to-severe AS with preserved left ventricular ejection fraction (LVEF ≥ 50%) were recruited and stratified into 3 groups based on index echocardiogram-(1) HG DIS- AS, (2) HG CON- AS and (3) moderate AS (M OD -AS). The primary study endpoints was all-cause mortality, with secondary endpoints of congestive heart failure (CHF) admissions and aortic valve replacement (AVR). Multivariable Cox regression was used and Kaplan-Meier curves were constructed to evaluate associations between HG DIS -AS, HG CON -AS and M OD -AS, and the study outcomes. A total of 467 patients were studied, comprising of 6.2% HG DIS- AS, 13.9% HG CON -AS and 79.9% M OD -AS patients. There was significantly higher AVR rates in the HG CON -AS group (58.5%), followed by HG DIS -AS (31.0%) and M OD -AS (4.6%), p < 0.001) groups. After adjusting for confounders, HG CON -AS was significantly associated with all-cause mortality (HR 3.082, 95% CI 1.479-6.420, p = 0.003) and CHF admissions (HR 12.728, 95% CI 2.922-55.440 p = 0.001) but not HG DIS -AS, with M OD -AS as the reference group. Both HG DIS -AS (HR 7.715, 95% CI 2.927-20.338; p < 0.001) and HG CON -AS (HR 21.960, 95% CI 10.833-44.515, p < 0.001) were independent predictors of AVR. After exclusion of reversible high-flow states, HG DIS -AS patients appear to have a more favourable prognostic profile compared to HG CON -AS patients. Large prospective interventional studies examining the prognostic differences between the two groups will be the next important step.