Key result
This review highlights that accurate diagnosis of true severe low-flow low-gradient aortic stenosis requires multimodality imaging, and that aortic valve replacement offers prognostic benefits over medical therapy despite high perioperative risks.
Why the study?
Low-flow low-gradient aortic stenosis with reduced left ventricle ejection fraction remains a diagnostic and therapeutic challenge.
Emerging diagnostic tools like projected aortic valve area and CCT calcium scoring improve the identification of true severe LFLG AS, guiding the choice between surgical, transcatheter, or medical therapy.
Low-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.
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Contorni et al. (2021) conducted a review in Low-flow low-gradient aortic stenosis with reduced left ventricle ejection fraction. This review highlights that accurate diagnosis of true severe low-flow low-gradient aortic stenosis requires multimodality imaging, and that aortic valve replacement offers prognostic benefits over medical therapy despite high perioperative risks.
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