Paradoxical Low-Flow Aortic Stenosis May Be Worse Than It Seems

In a retrospective matched-cohort analysis, patients with PLF-AS had a higher mortality risk than those with either severe or moderate disease.

The recognition that some patients with severe aortic stenosis (AS) have lower-than-usual gradients and normal left ventricular ejection fractions (LVEFs) due to low flow — a condition termed “paradoxical low-flow aortic stenosis” (PLF-AS) — is relatively recent (JW Cardiol Mar 23 2011). Prognosis and treatment in such cases are controversial. In this Canadian study, investigators retrospectively compared outcomes in 187 patients with PLF-AS (aortic valve area ≤1.0 cm², LVEF ≥50%, mean gradient <40 mm Hg, stroke volume index <35 mL/m²) with those in 187 matched patients with moderate AS and in 187 matched patients with high-gradient severe AS.

Compared with patients with moderate or high-gradient AS, those with PLF-AS were older, were more l…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI