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Paradoxical Low Flow Aortic Valve Stenosis: Incidence, Evaluation, and Clinical Significance

  • Valvular Heart Disease (V Nkomo, Section Editor)
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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.

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Compliance with Ethics Guidelines

Conflict of Interest

Marie-Annick Clavel declares that she has no conflict of interest.

Philippe Pibarot has received grant support from Edwards Life Sciences for the Echo CoreLab for TAVR Study.

Jean G. Dumesnil declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Institut Universitaire de Cardiologie et de Pneumologie de Québec / Quebec Heart and Lung Institute (Canada), 2527 Chemin Sainte-Foy – U3775, Québec, QC, G1V 4G5, Canada

    Marie-Annick Clavel

  2. Institut Universitaire de Cardiologie et de Pneumologie de Québec / Quebec Heart and Lung Institute (Canada), 2527 Chemin Sainte-Foy – Y4165, Québec, QC G1V 4G5, Canada

    Philippe Pibarot

  3. Institut Universitaire de Cardiologie et de Pneumologie de Québec / Quebec Heart and Lung Institute (Canada), 2527 Chemin Sainte-Foy – Y4186, Québec, QC, G1V 4G5, Canada

    Jean G. Dumesnil

Authors
  1. Marie-Annick Clavel
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  2. Philippe Pibarot
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Correspondence to Marie-Annick Clavel.

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This article is part of the Topical Collection on Valvular Heart Disease

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Clavel, MA., Pibarot, P. & Dumesnil, J.G. Paradoxical Low Flow Aortic Valve Stenosis: Incidence, Evaluation, and Clinical Significance. Curr Cardiol Rep 16, 431 (2014). https://doi.org/10.1007/s11886-013-0431-x

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  • DOI: https://doi.org/10.1007/s11886-013-0431-x

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