Abstract
Incumbent to the diagnosis of paradoxical low-flow, low-gradient severe aortic stenosis (LFLG AS) is a low indexed stroke volume (SVi) being < 35 mL/m2. This crucial value, with purported prognostic significance, is now embedded in the valve guidelines from the European Society of Cardiology and the ACC/AHA. However, measuring the LV outflow tract (LVOT) diameter necessary to derive SVi is fraught with error and poor reproducibility. In addition, the LVOT is not circular but rather elliptical, adding to the discrepancies in estimating SVi. As the SVi is typically calculated from Doppler as part of the continuity equation for calculating the aortic valve area (AVA), we postulate that calculating SVi from 2D volumes (thereby eliminating the LVOT measurement) may reclassify some of these patients.
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