Low-gradient aortic stenosis
Why the study?
The management of low-gradient aortic stenosis is challenging because the discrepancy between valve area and gradient raises uncertainty regarding stenosis severity and the indication for aortic valve replacement.
Design
Review
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
RARick A. NishimuraProfessor of cardiovascular diseases, Mayo Clinic
“Almost all of these patients with low-flow severe aortic stenosis with preserved ejection fraction are going to be hypertensive. Treat the hypertension first. If they become asymptomatic, you don't need to intervene. The aortic stenosis wasn't causing their symptoms. You can afford to continue to watch them.”
“Low-flow, low-gradient severe AS with preserved LVEF is a clinical condition that is frequently accompanied by comorbidities that inherently have an impact on prognosis and may explain, at least in part, the worse outcome observed.”
VTVuyisile T. NkomoCardiologist, Mayo Clinic Rochester
“Discordant aortic stenosis severity, especially during atrial fibrillation, should prompt an immediate comprehensive and integrative evaluation for severe aortic stenosis. The presence of high-signal gradients facilitates diagnosis of severe aortic stenosis.”
Implication
Complicates AVR decision-making in symptomatic low-gradient AS; leaves open optimal adjunctive testing to clarify true severity.
Structured PICO
P
Population
Patients with low-gradient aortic stenosis (aortic valve area <1.0 cm2 and mean transvalvular gradient <40 mmHg), including classical low-flow, paradoxical low-flow, and normal-flow variants.
I
Intervention
Diagnostic evaluation (dobutamine stress echocardiography, multi-detector computed tomography calcium scoring) and aortic valve replacement (surgical or transcatheter).
Accurate differentiation between true-severe and pseudo-severe low-gradient aortic stenosis using multimodality imaging is essential to identify patients who will benefit from aortic valve replacement.
Cite This Study
Clavel et al. (2016) studied this question.