Why the study?
Doppler velocity and pressure gradient-based assessment of aortic valve stenosis is flow dependent, requiring careful evaluation of true severity during high-flow states.
Doppler-based assessment of aortic stenosis severity is highly flow-dependent and requires careful interpretation in patients with conditions altering transaortic flow, such as bradycardia and atrial fibrillation.
Flow dependence warrants cautious AS severity grading in high-flow states; case leaves optimal flow-adjusted protocols open.
Doppler velocity and pressure gradient–based assessment of aortic valve stenosis (AS) is flow dependent. For a given aortic valve orifice area, both velocity and pressure gradient increase with elevated transaortic flows and decrease with reduction in flow rates. Therefore, assessment of the true severity of AS should be carefully performed during high-flow states, accounting for the factors that can profoundly affect flow across the aortic valve. We describe a challenging case of assessing AS severity in the setting of bradycardia from complete heart block (CHB), normal left ventricle (LV) function, permanent atrial fibrillation (AF), and moderate AS at baseline.
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Wang et al. (2022) studied this question.
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