Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis

Area of Science:

• Cardiology
• Echocardiography
• Valvular Heart Disease

Background:

• Severe aortic stenosis (AS) is classified into high-gradient (HG), normal-flow low-gradient (NFLG), and low-flow low-gradient (LFLG) subtypes.
• Understanding the progression of LFLG AS is crucial for patient management and predicting outcomes.

Purpose of the Study:

• To compare the disease progression and echocardiographic variable evolution in patients with severe LFLG AS versus other severe AS subtypes.
• To analyze changes in aortic valve area (AVA) and mean gradient over time.

Main Methods:

• A longitudinal, observational, multicenter study included 903 asymptomatic patients with severe AS and normal left ventricle ejection fraction.
• Patients were categorized at baseline into HG, NFLG, or LFLG groups based on echocardiographic parameters.
• AS progression was assessed by comparing baseline and follow-up measurements, including AVA and mean gradient.

Main Results:

• The mean gradient progression was greater in LFLG and NFLG groups compared to the HG group.
• Aortic valve area reduction was slower in the LFLG group than in the NFLG group.
• During follow-up, a significant proportion of LFLG patients evolved to NFLG or HG AS, with many undergoing aortic valve replacement for HG AS.

Conclusions:

• Low-flow low-gradient AS exhibits intermediate progression of AVA and gradient compared to NFLG and HG AS.
• Most patients initially diagnosed with LFLG AS transition to other severe AS forms, frequently requiring aortic valve replacement for high-gradient AS.