Paradoxical low-flow, low-gradient severe aortic stenosis: a distinct disease entity

The robustness of the flow-gradient classification of severe aortic stenosis

“… 2 The patient characteristics that distinguish the flow-gradients patterns are moderately understood, and the reported features are quite heterogeneous. 17 Bavishi and colleagues 18 reported high incidences of coronary artery disease in the low-flow groups and frequent atrial fibrillation and a small indexed left ventricular end-diastolic volume in patients in the PLFLG group. For the LFHG group, Eleid and colleagues 19 found that the AVA and AVAi was smallest and that the incidence of diabetes mellitus was relatively high.…”

Echodynamics: Interpretation, Limitations, and Clinical Integration!

“…However, paradoxical LFLG AS had been reported in 20% to 50% of patients with normal LVEF due to mitral pathologies, subclinical LV dysfunction, or DD. 66,67 Correct AS diagnosis and grading are fundamental as contributing factor in impaired perfusion, but it affects vasoactive drug choice (harm of vasodilators) and target blood pressure (BP; tight AS has premorbid lower BP). Suspicion should be raised when cusps are calcified with reduced mobility, especially when aortic VTI or measured SV is low.…”