82 - Low-Flow, Low-Gradient Aortic Stenosis With Reduced Left Ventricular Ejection Fraction

Abstract

In low-flow, low-gradient (LF-LG) aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF), the aortic valve area (AVA) is less than 1.0 cm2, suggesting the presence of severe AS, but the mean transvalvular gradient (MG) is less than 40mm Hg, consistent with the presence of moderate AS. The distinction between true versus pseudo-severe AS is key for therapeutic decision making in LFLG AS. This goal is generally achieved with the use of low-dose dobutamine stress echocardiography. In the substantial proportion of patients in whom the discordance between AVA and MG persists because of insufficient (or excessive) inotropic response, the distinction of true from pseudo-severe AS can be addressed by flow-independent diagnostic tools such as the projected AVA at normal flow rate or the aortic valve calcium score measured by multidetector computed tomography. Patients with confirmed true-severe AS should be referred to aortic valve replacement, and those with pseudo-severe AS should be followed up closely.