Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction

Authors: Pibarot, PhilippeDumesnil, Jean G.
Abstract: Low-flow, low-gradient (LF-LG) aortic stenosis (AS) may occur with depressed or preserved left ventricular ejection fraction (LVEF), and both situations are among the most challenging encountered in patients with valvular heart disease. In both cases, the decrease in gradient relative to AS severity is due to a reduction in transvalvular flow. The main challenge in patients with depressed LVEF is to distinguish between true severe versus pseudosevere stenosis and to accurately assess the severity of myocardial impairment. Paradoxical LF-LG severe AS despite a normal LVEF is a recently described entity that is characterized by pronounced LV concentric remodeling, small LV cavity size, and a restrictive physiology leading to impaired LV filling, altered myocardial function, and worse prognosis. Until recently, this entity was often misdiagnosed, thereby causing underestimation of AS severity and inappropriate delays for surgery. Hence, the main challenge in these patients is proper diagnosis, often requiring diagnostic tests other than Doppler echocardiography. The present paper proposes to review the diagnostic and therapeutic management specificities of LF-LG AS with and without depressed LV function.
Document Type: Article de recherche
Issue Date: 6 November 2012
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/3708
This document was published in: Journal of the American College of Cardiology, Vol. 60 (19), 1845–1853 (2012)
https://doi.org/10.1016/j.jacc.2012.06.051
Elsevier
Alternative version: 10.1016/j.jacc.2012.06.051
23062546
Collection:Articles publiés dans des revues avec comité de lecture

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