Paradoxical low flow aortic valve stenosis : incidence, evaluation, and clinical significance

Authors: Clavel, Marie-AnnickPibarot, PhilippeDumesnil, Jean G.
Abstract: Paradoxical low-flow (PLF) aortic stenosis is defined by a stroke volume index <35 ml/m2 despite the presence of preserved LV ejection fraction (=50 %). This entity is typically characterized by pronounced LV concentric remodeling with small LV cavity, impaired LV filling, increased arterial load, and reduced LV longitudinal shortening. Patients with PLF also have a worse prognosis compared to patients with normal flow. Because of the low flow state, these patients often have a low gradient despite the presence of severe stenosis, thus leading to discordant AS grading (i.e., aortic valve area¿<¿1.0 cm2 but mean gradient¿<¿40 mmHg) and thus uncertainty about the indication of aortic valve replacement. Stress echocardiography and aortic valve calcium score by computed tomography may be helpful to differentiate true from pseudo severe stenosis and thereby guide therapeutic management in these patients. Aortic valve replacement improves outcomes in patients with PLF low gradient AS having evidence of severe stenosis. Transcatheter aortic valve replacement may provide an interesting alternative to surgery in these patients.
Document Type: Article de recherche
Issue Date: 1 January 2014
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/2308
This document was published in: Current Cardiology Reports, Vol. 16 (1), 1–7 (2014)
http://dx.doi.org/10.1007/s11886-013-0431-x
Springer
Alternative version: 10.1007/s11886-013-0431-x
http://www.ncbi.nlm.nih.gov/pubmed/24343152
Collection:Articles publiés dans des revues avec comité de lecture

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