Clinical and echocardiographic differences between paradoxical low-flow, low-gradient aortic stenosis and classical aortic stenosis: Prognostic implications after TAVI implantation

Abstract Introduction and objectives Paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS) with preserved left ventricular ejection fraction (LVEF) is associated with a more complex physiology, worse functional outcomes, higher rates of therapeutic futility, and hospital readmissions after transcatheter aortic valve implantation (TAVI) compared with classical high-gradient aortic stenosis (CAS). However, its impact on mortality remains inconclusive. This study aims to characterize and compare the clinical and echocardiographic profile of patients with PLF-LG AS vs CAS. Additionally, we aim to analyse the incidence of clinical events during follow-up (heart failure hospitalizations and mortality) post-TAVI. Methods Retrospective analysis of a prospective single-centre cohort of patients with severe AS treated with TAVI at a tertiary centre between 2008 and 2023. Out of 1134 patients, those with LVEF