Classical and Paradoxical Low-Flow Low-Gradient Aortic Stenosis: A Heart Failure Perspective

This review explores low-flow low-gradient aortic stenosis from a heart failure perspective, describing the mechanisms and consequences for diagnosis, prognosis and management. The review clarifies that low-flow low-gradient aortic stenosis does not necessarily imply severe aortic stenosis with consequent low-flow; it implies aortic stenosis of indeterminate severity because of low-flow caused by ventricular compensatory mechanisms to the aortic stenosis or by coexistent pathology. The review highlights the central and evolving role of transcatheter aortic valve replacement in low-flow low-gradient aortic stenosis, because afterload reduction by replacing the valve is essential for the management of heart failure, the surgical risk is higher and it is important to avoid patient-prosthesis mismatch.