Assessment of low-flow, low-gradient, severe aortic stenosis: an invasive evaluation is required for decision making.

O'Sullivan, Crochan John; Praz, Fabien; Stortecky, Stefan; Windecker, Stephan; Wenaweser, Peter Martin (2014). Assessment of low-flow, low-gradient, severe aortic stenosis: an invasive evaluation is required for decision making. EuroIntervention, 10 Suppl U, U61-U68. Europa Digital & Publishing 10.4244/EIJV10SUA9

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Low-flow, low-gradient severe aortic stenosis (AS) is characterised by a small aortic valve area (AVA) and low mean gradient (MG) secondary to a low cardiac output and may occur in patients with either a preserved or reduced left ventricular ejection fraction (LVEF). Symptomatic patients presenting with low-flow, low-gradient severe AS have a dismal prognosis independent of baseline LVEF if managed conservatively and should therefore undergo aortic valve replacement if feasible. Transthoracic echocardiography (TTE) is the first-line investigation for the assessment of AS haemodynamic severity. However, when confronted with guideline-discordant AVA (small) and MG (low) values, there are several reasons other than severe AS combined with a low cardiac output which may lead to such a situation, including erroneous measurements, small body size, inherent inconsistencies in the guidelines' criteria, prolonged ejection time and aortic pseudostenosis. The distinction between these various entities poses a diagnostic challenge. However, it is important to make a distinction because each has very different implications in terms of risk stratification and therapeutic management. In such instances, cardiac catheterisation forms an integral part of the work-up of these patients in order to confirm or refute the echocardiographic findings to guide management decisions appropriately.

Item Type:

Journal Article (Further Contribution)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

O'Sullivan, Crochan John, Praz, Fabien Daniel, Stortecky, Stefan, Windecker, Stephan, Wenaweser, Peter Martin


600 Technology > 610 Medicine & health




Europa Digital & Publishing




Judith Liniger

Date Deposited:

06 May 2015 09:00

Last Modified:

02 Mar 2023 23:25

Publisher DOI:


PubMed ID:



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