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This editorial highlights the evidentiary gaps in transcatheter aortic valve replacement for low-flow, low-gradient aortic stenosis and calls for prospective, multicenter studies incorporating advanced myocardial damage markers and quality-of-life endpoints.
The 2020 American College of Cardiology/American Heart Association guidelines endorse a class I recommendation for symptomatic severe aortic valve stenosis (AS) regardless of the subtype that spans classic high-flow high-gradient AS (stage D1), classic low-flow low-gradient (cLFLG) with reduced ejection fraction (EF, stage D2), and paradoxical low-flow low-gradient (pLFLG) characterized by preserved EF >50% (stage D3).1 The natural history of the D2 subtype has a poorer overall prognosis compared with D1 or D3, as has been corroborated by multiple studies.
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Jagadeesan et al. (2024) studied this question.
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