Severe mitral stenosis as a cause of paradoxical low-flow, low-gradient severe aortic stenosis: an explorative study on hemodynamics and outcomes
Bibliographic record
Abstract
Background Aortic stenosis (AS) and mitral stenosis (MS) are valvular heart diseases that may present concomitantly, particularly in regions where rheumatic heart disease remains prevalent. While each condition has been extensively studied in isolation, there is limited data on the clinical characteristics of patients with combined AS-MS. Methods We retrospectively identified patients with significant AS and concomitant significant MS from the echocardiography database between 2003 and 2018. Exclusion criteria included left ventricular ejection fraction <50%, other significant valvular lesions, prior cardiac surgery, and associated congenital heart disease. Patients with isolated AS were compared to patients with combined AS-MS. Results Of 1470 patients with severe AS, a total of 353 patients were included: 41 with combined AS-MS and 312 with isolated AS. The prevalence of combined AS-MS was 11% among patients with significant AS. Compared to patients with isolated AS, patients with combined AS-MS were significantly younger (50 vs. 63 years, p < 0.001), had a lower prevalence of hypertension (44% vs. 64%, P = 0.017) and diabetes (22% v. 42%, p = 0.013), and a greater prevalence of atrial fibrillation (17% vs. 5%, p = 0.003). Patients with combined AS-MS had a significantly larger left atrial size (4.79 ± 0.70 cm vs. 3.93 ± 0.73 cm, p < 0.001), higher peak tricuspid velocities (3.14 ± 0.59 m/s vs. 2.72 ± 0.45 m/s, p < 0.001), and greater prevalence of moderate or severe tricuspid regurgitation (15% vs. 1%, p < 0.001). Echocardiographic parameters assessing transvalvular flow rate did not differ significantly between the two groups. After multivariate adjustment for age and gender combined AS-MS was associated with worse 5-year overall survival (HR 2.672, 95% CI 1.060–6.732, p = 0.037). Conclusion Combined mitral and aortic stenosis is not uncommon (11%) but linked to worse outcomes than isolated AS. Despite expectations, concomitant significant MS did not increase prevalence of paradoxical low-flow, low-gradient AS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".