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European Heart Journal Advance Access published online on September 8, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp361
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment

Jean G. Dumesnil1,*, Philippe Pibarot1,* and Blase Carabello2

1 Department of Medicine, Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec, Québec, Canada, G1V 4G5
2 Department of Medicine, The W.A. ‘Tex’ and Deborah Moncrief, Jr Chair, Baylor College of Medicine, Medical Care Line Executive, and Veterans Affairs Medical Center, Houston, TX, USA

Received 6 March 2009; revised 17 May 2009; accepted 18 June 2009 * Corresponding author. Tel: +1 418 656 4767, Fax: +1 418 656 4562, Email: jean.dumesnil{at}med.ulaval.ca (J.G.D.) or philippe.pibarot{at}med.ulaval.ca (P.P.)

Paradoxical low flow, low gradient, severe aortic stenosis (AS) despite preserved ejection fraction is a recently described clinical entity whereby patients with severe AS on the basis of aortic valve area have a lower than expected gradient in relation to generally accepted values. This mode of presentation of severe AS is relatively frequent (up to 35% of cases) and such patients have a cluster of findings, indicating that they are at a more advanced stage of their disease and have a poorer prognosis if treated medically rather than surgically. Yet, a majority of these patients do not undergo surgery likely due to the fact that the reduced gradient is conducive to an underestimation of the severity of the disease and/or of symptoms. The purpose of this article is to review and further analyse the distinguishing characteristics of this entity and to present its implications with regards to currently accepted guidelines for AS severity.

Key Words: Aortic valve stenosis • Severity • Low-gradient • Echocardiography • Hypertension


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