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Low-flow, low-gradient severe aortic stenosis in patients with normal ejection fraction.
Jean G Dumesnil1, Philippe Pibarot
1Department of Medicine, Québec Heart & Lung Institute, Laval University, Québec City, Québec, Canada. jean.dumesnil@med.ulaval.ca
Current Opinion in Cardiology
|July 10, 2013
Summary
Low-flow, low-gradient severe aortic stenosis with normal ejection fraction is a recently described condition. Differentiating this from normal-flow, low-gradient aortic stenosis is crucial for prognosis and management.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Echocardiography
Background:
- Severe aortic stenosis (AS) is typically associated with high gradients.
- Low-flow, low-gradient (LFLG) severe AS in patients with preserved left ventricular ejection fraction (LVEF) is a recently recognized entity.
- This condition shares similarities with heart failure with preserved ejection fraction, stemming from restrictive physiology.
Purpose of the Study:
- To review the diagnostic and management specificities of LFLG severe AS in patients with normal LVEF.
- To highlight the clinical relevance and prognostic implications of this condition.
Main Methods:
- Review of current guidelines (ACC/AHA, ESC/EACTS).
- Analysis of recent studies on LFLG severe AS.
- Comparison of LFLG severe AS with normal-flow, low-gradient AS.
Main Results:
- LFLG severe AS occurs in 10-25% of patients with severe AS and normal LVEF.
- This entity is characterized by concentric left ventricular remodeling, smaller LV cavity size, and reduced LV compliance.
- European guidelines now recognize the clinical relevance of LFLG severe AS, emphasizing confirmation of low-flow conditions.
Conclusions:
- Distinguishing bona fide paradoxical LFLG severe AS from normal-flow, low-gradient AS is critical.
- Patients with paradoxical LFLG severe AS have a worse prognosis compared to those with normal-flow, low-gradient AS.
- Accurate diagnosis and management strategies are essential for improving outcomes in this patient population.
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