Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF.

The objective of this study was to examine the value of stress-echocardiography in patients with paradoxical low-flow, low-gradient (PLFLG) aortic stenosis (AS). The projected aortic valve area (AVA Proj ) at a normal flow rate was calculated in 55 patients with PLFLG AS. In the subset of patients (n = 13) who underwent an aortic valve replacement within 3 months after stress echocardiography, AVA Proj correlated better with the valve weight compared to traditional resting and stress echocardiographic parameters of AS severity (AVA Proj : r = −0.78 vs. other parameters: r = 0.46 to 0.56). In the whole group (N = 55), 18 (33%) patients had an AVA Proj >1.0 cm 2 , being consistent with the presence of pseudo severe AS. The AVA Proj was also superior to traditional parameters of stenosis severity for predicting outcomes (hazard ratio: 1.32/0.1 cm 2 decrease in AVA Proj ). In patients with PLFLG AS, the measurement of AVA proj derived from stress echocardiography is helpful to determine the actual severity of the stenosis and predict risk of adverse events.