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Published on: October 20, 2023
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Paradoxical aortic stenosis: A systematic review
Rita Cavaca1, Rogério Teixeira2, Maria João Vieira3
1Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
Summary
Paradoxical low-flow, low-gradient aortic stenosis (AS) affects 3-35% of severe AS patients, often older females. This condition involves specific heart changes and may require valve replacement.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Vascular Medicine
Background:
- Aortic stenosis (AS) is a prevalent valvular and vascular disease.
- Paradoxical low-flow, low-gradient AS presents with severe AS (AVA ≤1 cm²/indexed AVA ≤0.6 cm²/m²) but low gradient (<40 mmHg) and low stroke volume index (≤35 ml/m²) despite preserved ejection fraction (≥50%).
Purpose of the Study:
- To review the literature on paradoxical low-flow, low-gradient aortic stenosis between 2007-2014.
- To understand the prevalence, characteristics, and diagnostic challenges of this AS subtype.
Main Methods:
- A systematic literature search was conducted in the PubMed database for paradoxical AS.
- 57 articles published between 2007 and 2014 were included in the review.
Main Results:
- The prevalence of paradoxical AS ranges from 3% to 35% in severe degenerative AS, being more common in females and older individuals.
- This condition is linked to distinct left ventricular remodeling and increased systemic arterial stiffness.
- Potential inaccuracies in aortic valve area calculation by the continuity equation can lead to misdiagnosis of the paradoxical phenotype.
Conclusions:
- Newer diagnostic tools like aortic valve calcium score, valvuloarterial impedance, and left ventricular longitudinal mechanics aid AS assessment.
- The natural history and distinct phenotype of paradoxical AS require further investigation.
- Surgical or percutaneous valve replacement may be considered for severe, symptomatic paradoxical AS.
Keywords:
Baixo fluxo sistólicoBaixo gradienteDiagnosisDiagnósticoEstenose aórtica paradoxalLow gradientLow systolic flowParadoxical aortic stenosisPrognosisPrognósticoRigidez vascularTratamentoTreatmentVascular stiffnessMore Related Videos
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