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Low-flow/low-gradient aortic stenosis without contractile reserve-a case report.
Lukas Stastny1, Julia Dumfarth1, Guy Friedrich2
1Department of Cardiac surgery, Medical University Innsbruck, Anichstraße 35, Austria.
European Heart Journal. Case Reports
|July 20, 2022
Summary
Diagnosing low-flow/low-gradient aortic stenosis requires advanced imaging. Dobutamine stress echocardiography and cardiac computed tomography are crucial for accurate assessment and management of this challenging condition.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Low-flow/low-gradient aortic stenosis (LF/LGAS) presents diagnostic challenges.
- Resting echocardiography alone is insufficient for differentiating LF/LGAS subtypes.
- Advanced imaging modalities are essential for comprehensive assessment.
Observation:
- A 73-year-old woman with NYHA III symptoms presented with exertional dyspnea, fatigue, and low resilience.
- Physical examination revealed a systolic murmur over the aortic valve.
- Diagnostic workup identified LF/LGAS without contractile reserve (CR) on dobutamine stress echocardiography (DSE) and significant valve calcification on cardiac computed tomography (CCT).
Findings:
- Dobutamine stress echocardiography (DSE) revealed no contractile reserve (CR).
- Cardiac computed tomography (CCT) demonstrated massive valve calcification.
- The case highlights the necessity of integrating DSE and CCT for LF/LGAS diagnosis.
Implications:
- Current guidelines support treating LF/LGAS patients even without CR, necessitating accurate diagnostic tools.
- This case underscores the importance of advanced imaging in managing complex aortic stenosis.
- Re-evaluation of LF/LGAS prognosis emphasizes the need for precise diagnostic workflows.
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