Prediction of symptom development and aortic valve replacement in patients with low-gradient severe aortic stenosis.

Aims: Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe aortic stenosis (AS) is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population. Methods and results: This retrospective observational study included 122 consecutive asymptomatic patients with either moderate [mean pressure gradient (MPG) < 40 mmHg and aortic valve area (AVA) 1.0-1.5 cm2] or low-gradient severe (MPG < 40 mmHg and AVA < 1.0 cm2) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients [76.5 (71.0-80.3) years; 48.3% male] were included in this study. During a median follow-up period of 989 (578-1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, P < 0.001). Multivariable Cox regression analysis showed that the mitral E/e' ratio during exercise was independently associated with AS-related events (hazard ratio = 1.075, P < 0.001) in patients with low-gradient severe AS. Conclusion: This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral E/e' ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.

Characterization of the Volume-based or Number-based Size Distribution for Silica Nanoparticles Using a Unique Combination of Online Dynamic Light Scattering Having a Uni-tau Multi-bit Correlator and High-resolution Centrifugal Field-Flow Fractionation Separator.

This paper presents a study of the size distributions of colloidal nanoparticles using an online dynamic light scattering (DLS) unit with a uni-tau multi-bit correlator (UMC) combined with a centrifugal field-flow fractionation (CF3) separator. Conventionally, the FFF-UV-MALS system utilizing field-flow fractionation (FFF) combined with a UV detector and multi-angle light scattering instrument (MALS) could be used to obtain the particle size distribution of colloidal nanoparticles. Lately, DLS as a technique to measure the size distributions of colloid materials has become prevalent. However, the DLS instrument will practically measure only the large particles in a multi-modal particle mixture. Therefore, the CF3-DLS w/UMC system that was developed consisted of a CF3 unit connected to an online DLS instrument with UMC. The system could measure the volume- or number-based size distribution with highly quantitative and accurate histograms for multi-modal samples. The size distributions were validated with size distributions obtained by images of an atomic force microscope (AFM). Two types of colloidal silica nanoparticles with different distribution widths were used in this study.