Meta-analysis of the outcome of patients with low gradient severe aortic stenosis and preserved left ventricular ejection fraction

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A number of patients with severe aortic valve stenosis (AS) as defined on the basis of aortic valve area (AVA) have low transvalvular gradient. When associated with a reduced left ventricular ejection fraction (LVEF), this condition is called low flow-low gradient AS [1]. Since gradient measurement is flow dependent, decreased LVEF may explain the low gradient. Nevertheless, low gradient severe AS can be associated also with preserved LVEF. Management of this subgroup of patients is controversial because of the limited amount of data on its prevalence, natural history and outcome after aortic valve replacement (AVR) [2,3].