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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
PubMed

Insights

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.
Abstract

Keywords:
Cardiac computed tomographyCase reportDobutamine stress echocardiographyLow-flow/low-gradient aortic stenosis

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