[Paradoxical low flow-low gradient aortic stenosis: lights and shadows].

Area of Science:

• Cardiology
• Valvular Heart Disease
• Geriatric Medicine

Context:

• Paradoxical low flow-low gradient aortic valve stenosis (AVS) is an increasing phenotype, especially in individuals over 70.
• This condition presents with preserved ejection fraction but a low transvalvular gradient, complicating diagnosis.
• Its pathophysiology is often linked to heart failure with preserved ejection fraction, arterial hypertension, and cardiac amyloidosis.

Purpose:

• To clarify the diagnostic role and reliability of key methods for paradoxical low flow-low gradient AVS.
• To evaluate the efficacy of surgical and percutaneous treatments for this condition.
• To develop a diagnostic-therapeutic algorithm for practical clinical management.

Summary:

• A multi-parametric evaluation approach is proposed, integrating echocardiography, 3D planimetric valve area, energy loss index, and CT calcium scoring.
• This comprehensive assessment aims to accurately determine stenosis severity.
• The algorithm will guide appropriate therapeutic management decisions.

Impact:

• Improved diagnostic accuracy for paradoxical low flow-low gradient AVS.
• Standardized and evidence-based therapeutic strategies for this complex patient group.
• Enhanced clinical decision-making and patient outcomes in geriatric cardiology.