Paradoxical Low Flow/Low Gradient Severe Aortic Stenosis: an Emerging Phenotype in Older Adults with Valve Disease

Abstract

Aortic stenosis is a common disorder in older adults and is the second most common reason for open heart surgery. Paradoxical low flow/low gradient severe aortic stenosis, defined by a stroke volume index ≤35 mL/m2 with an left ventricular ejection fraction (EF) (LVEF) ≥50 %, is a recently recognized subset of aortic stenosis. It presents a unique challenge in diagnosis and management particularly in the elderly population. Physiologic changes of aging contribute to the development of this phenotype and its prevalence and true prognosis remains in dispute. Management options have expanded from surgical to minimally invasive transcatheter methods. Future investigations will improve our understanding of the physiologic basis of this condition and hold great promise to improve outcomes amongst older adults with paradoxically low flow aortic stenosis.