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Paradoxical Low Flow/Low Gradient Severe Aortic Stenosis: an Emerging Phenotype in Older Adults with Valve Disease

  • Cardiovascular Disease in the Elderly (DE Forman, Section Editor)
  • Published:
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Abstract

Aortic stenosis is a common disorder in older adults and is the second most common reason for open heart surgery. Paradoxical low flow/low gradient severe aortic stenosis, defined by a stroke volume index ≤35 mL/m2 with an left ventricular ejection fraction (EF) (LVEF) ≥50 %, is a recently recognized subset of aortic stenosis. It presents a unique challenge in diagnosis and management particularly in the elderly population. Physiologic changes of aging contribute to the development of this phenotype and its prevalence and true prognosis remains in dispute. Management options have expanded from surgical to minimally invasive transcatheter methods. Future investigations will improve our understanding of the physiologic basis of this condition and hold great promise to improve outcomes amongst older adults with paradoxically low flow aortic stenosis.

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Abbreviations

AVR:

Aortic valve replacement

EF:

Ejection fraction

HG:

High gradient

LG:

Low gradient

LV:

Left ventricle

MDCT:

Multidetector cardiac computed tomography

NF:

Normal flow

pLF:

Paradoxical low flow

pLVEF:

Preserved left ventricular ejection fraction

SAC:

Systemic arterial compliance

sAS:

Severe aortic stenosis

SAVR:

Surgical aortic valve replacement

SVI:

Stroke volume index

SVR:

Systemic vascular resistance

TAVR:

Transcatheter aortic valve replacement

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Acknowledgments

Dr. Maurer is funded by a K24 Award from NIA AG036778-05 entitled “Midcareer Mentoring Award in Geriatric Cardiology”.

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The authors declare that they have no competing interests.

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. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA

    Lakshmi Sridharan & Mathew S. Maurer

  2. College of Physicians and Surgeons, Columbia University, 630 West 168th Street, Box 93, PH 10-203, New York, NY, 10032, USA

    Lakshmi Sridharan

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  1. Lakshmi Sridharan
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  2. Mathew S. Maurer
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Correspondence to Lakshmi Sridharan.

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This article is part of the Topical Collection on Cardiovascular Disease in the Elderly

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Sridharan, L., Maurer, M.S. Paradoxical Low Flow/Low Gradient Severe Aortic Stenosis: an Emerging Phenotype in Older Adults with Valve Disease. Curr Geri Rep 4, 353–361 (2015). https://doi.org/10.1007/s13670-015-0139-4

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  • DOI: https://doi.org/10.1007/s13670-015-0139-4

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